Underactive bladder (UAB) is a common condition in urology clinics. However, it is under-researched, thereby resulting in insufficient and ineffective treatment options. Thus, the working group reviewed the literature to reach a consensus regarding the management of UAB.

The working group comprised of twenty-three urological surgeons from all over India. We developed, debated, and ranked fourteen statements based on the body of literature that was available. Finally, the recommendations were noted. The group members were asked to score the statements on a 5-point Likert scale, where 1 represented "strongly disagree" and 5 represented "strongly agree." After calculating the percentage of members who scored a given statement, the consensus was categorized as strong, moderate, or weak depending on whether it was ≥80 percent, 50-79 percent, or ≤49 percent, respectively.

Of 14 statements, a strong consensus was reached for 10 statements: (i) Urodynamic studies are crucial in diagnosing UAB and determining the appropriate treatment approach; (ii) Crede/Valsalva maneuver should be avoided; (iii) Scheduled voiding and (iv) Double/triple voiding can be effective in patients with sensory impairment and intact urinary sensation, respectively; (v) Pelvic floor muscle relaxation training with biofeedback should be used in those with dysfunctional voiding; (vi) Clean intermittent self-catheterization should be the standard treatment for inability to empty the bladder; (vii) Suprapubic catheter is preferred in those refractory to all the above modalities; (viii) Patients with preserved detrusor function and (ix) Bladder outlet resistance may get symptomatic relief with parasympathomimetic agents and α-blockers, respectively; and (x) Combination therapy may be more effective than monotherapy, in patients with both the conditions. Moreover, two statements each had moderate and weak consensus.

Most of the statements had strong consensus. However, further high quality research is needed to formulate more inclusive statements in this evolving management of UAB.