Baseline Detrusor Overactivity Subtype and Impaired Detrusor Contractility Are Associated With Persistent Detrusor Overactivity After β3‐Adrenoceptor Agonist Add‐On Therapy in Men With Lower Urinary Tract Symptoms

ABSTRACT Objectives To identify baseline urodynamic factors associated with persistent detrusor overactivity (DO) after β3‐adrenoceptor agonist add‐on therapy in men with lower urinary tract symptoms (LUTS)/overactive bladder (OAB). Methods We retrospectively analyzed 270 men with LUTS/OAB despite ≥ 3 months of α1‐adrenoceptor antagonist or phosphodiesterase type 5 inhibitor monotherapy. All patients had DO on baseline urodynamics and underwent repeat urodynamic evaluation approximately 3 months after add‐on β3‐adrenoceptor agonist therapy. Baseline DO was classified as phasic, terminal, or combined. Patients were categorized into the DO disappearance and persistent DO groups. Baseline urodynamic parameters were compared, and logistic regression analyses were performed. Results DO disappeared in 129 patients (47.8%) and persisted in 141 (52.2%). The persistent DO group had significantly lower bladder contractility index (BCI), bladder voiding efficiency (BVE), and bladder outlet obstruction index; the overall DO subtype distribution differed significantly between the groups. In multivariable analysis, with phasic DO as the reference, terminal DO (adjusted odds ratio [OR], 3.08; 95% confidence interval [CI], 1.25–7.59), combined DO (adjusted OR, 4.58; 95% CI, 1.86–11.28), lower BCI (adjusted OR per 10‐unit increase, 0.67; 95% CI, 0.55–0.82), and lower BVE (adjusted OR per 10‐percentage‐point increase, 0.80; 95% CI, 0.66–0.97) were independently associated with persistent DO. The adjusted overall subtype effect was significant ( p  = 0.004). Conclusions A baseline terminal DO component and impaired detrusor contractility were independently associated with persistent DO after β3‐adrenoceptor agonist add‐on therapy. DO subtype and bladder contractility may help identify a potentially treatment‐resistant urodynamic phenotype in men with LUTS/OAB.