In the last years the symptom of unstable bladder behaviour has been interpreted with increasing clinical importance, sometimes being regarded as a diagnosis or as a causative factor for different complaints (1, 3–6, 16, 18, 20). The term ‘unstable bladder’ is still not precisely defined (17). Few investigations on this topic had been done in children, therefore, the urodynamic findings of 216 children were analysed to look for co-findings of bladder instability and, if possible, to demonstrate some causative factors. The investigations revealed that unstable bladder behaviour seems to be a secondary cystometric phenomenon (directly or indirectly induced). The treatment of unstable bladder should be concentrated on the causative disorder rather than on the cystometric symptom.

The urodynamic findings of 247 patients with a neurogenic bladder dysfunction were analyzed to evaluate factors which influence the X-ray picture of the bladder neck and urethra. Patients were classified according to the classification of Bors and Comarr, additionally different types of reflex detrusor activity could be differentiated in cases suffering from a supranuclear lesion. As the micturition cystourethrography of female patients with a supranuclear lesion looks similar to the X-ray picture of young girls with a WBNA a second analysis was made to compare the urodynamics of both groups. It is to note that in supranuclear lesions detrusor-sphincter dyssynergia and the type of reflex detrusor activity mainly form the shape of the posterior urethra, neither the duration of the lesion nor the level of spinal cord injury have any influence.

Urodynamic investigations were performed in 45 men, 25 women and 25 children with various forms of bladder outlet obstruction to define the stage of compensation and decompensation of the voiding system. Additionally routine diagnostic methods as history, rectal palpation, urine culture, endoscopy and excretory urogram were carried out. In adults the hyperactive decompensation of the detrusor could be differentiated from a hypoactive stage. The product of maximal differential pressure increase multiplied by maximal flow rate as a sign of voiding ‘efficiency’ can help to decide whether an obstruction must be treated or not. The size of the prostate diagnosed by rectal palpation or by endoscopic examination as well as the findings of the bougie à boule calibration of the urethra showed poor correlation to the urodynamic findings. In children flow rate is no reliable parameter for differentiation of compensation and decompensation of the system.

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