評論：
低活動性膀胱（underactive bladder，UAB），簡單的說，就是因膀胱逼尿肌收縮力不足所引起的一系列症狀，包括排尿速度變慢、或是膀胱排空能力不足以致餘尿量太多等。心臟是一個與膀胱有些類似但更為複雜的器官，鬱血性心衰竭(congestive heart failure)也是因為心肌收縮功能不佳所造成的一系列症狀，它的治療原則不外乎減少preload、增加心肌收縮力、及降低afterload。低活動性膀胱其實就是膀胱衰竭(bladder failure)，而泌尿科醫師面對這些症狀往往以膀胱出口阻塞的治療方式來處理(降低afterload)，或是加上副交感神經興奮劑如urecholine、膽鹼酶抑制劑（Cholinesterase inhibitor）如neostigmine輔助治療(企圖增強逼尿肌收縮力)，嚴重者就放置導尿管或是教導患者自我導尿。但是目前只有極少的證據顯示上述藥物有助於增強逼尿肌的收縮力，實驗也發現在老化的膀胱不但逼尿肌大量消失，其傳出運動神經元及軸突也大量減少及退化，說明為何上述藥物的作用不佳。目前最常用來治療UAB的甲型阻斷劑(alpha-blockers)可以降低尿道阻力，但是是否能增加膀胱的收縮力則不確定。目前知道增強傳入感覺神經的刺激可以增加膀胱的收縮力，除了substance P、ATP、neurokinins等神經傳導物質之外，膀胱lamina propria內的pacemaker cells將是未來對低活動性膀胱研究的重點。另外對三磷酸腺苷(ATP)、鉀離子通道、鈣離子通道、前列腺素E2、雌激素等在低活動性膀胱的角色都有待進一步研究。

另外幹細胞再生治療、基因療法、神經調節或是排尿輔助裝置(目前InFlow Intraurethral Valve-Pump已經由美國FDA核准上市)或許都是未來可以用來治療低活動性膀胱的方法之一，至於成效如何，就讓我們繼續看下去吧。

摘要：
Underactive bladder (UAB) is a term used to describe a constellation of symptoms that is perceived by patients suggesting bladder hypocontractility. Urodynamic measurement that suggest decreased contractility of the bladder is termed detrusor underactivity (DUA). Regulatory approved specific management options with clinically proven ability to increase bladder contractility do not currently exist. While DUA specific treatments presumably will focus on methods to increase efficiency of bladder emptying capability relying on augmenting the motor pathway in the micturition reflex, other approaches include methods to augment the sensory (afferent) contribution to the micturition reflex which could result in increased detrusor contractility. Another method to induce more efficient bladder emptying could be to induce relaxation of the bladder outlet. Using cellular regenerative techniques, the detrusor smooth muscle can be targeted so the result is to increase detrusor smooth muscle function. In this review, we will cover areas of potential new therapies for DUA including: drug therapy, stem cells and regenerative therapies, neuromodulation, and urethral flow assist device. Paralleling development of new therapies, there also needs to be clinical studies performed that address how DUA relates to UAB.