Children With Unstable Bladder: Clinical and Urodynamic Observation

Abstract

A clinical analysis was done on 303 patients diagnosed by urodynamic study as having an unstable bladder, which was characterized by uninhibited contraction of the detrusor without any overt neurogenic lesions. An age distribution histogram demonstrated 2 peaks: children less than 10 years old and patients between 60 and 80 years old. Sex was not significant in the children but men predominated in the adults. There were 68 children less than 15 years old with the chief complaints of enuresis (54 per cent), urge incontinence (41 per cent) and fever (25 per cent). The objective findings were vesicoureteral reflux in 29 children, urinary tract infection in 20 and distal urethral stenosis in 8. An unstable bladder type I, the occurrence of uninhibited contractions during the filling phase of cystometry, was found in 53 children (78 per cent). We noted several postures that the children characteristically used to resist unheralded urgency and to prevent urine from leaking. The main therapeutic regimen consisted of anticholinergics with or without antimicrobials. Several children underwent surgical intervention. Once the antireflux operation was performed followup with anticholinergics was of primary importance. The unstable bladders of 63 of the 68 children (93 per cent) have been controlled satisfactorily. The etiology of bladder instability is discussed for both groups of patients.

Detrusor Instability in Children with Recurrent Urinary Tract Infection and/or Enuresis

“…The importance of reproducibility of DI has pre viously been emphasized, since the demand for complete reproducibility during three consecutive cystometries re duced the incidence of DI from about 80 to 60% in chil dren with UTI and/or enuresis [3], Should complete reproducibility have been requested in our study, only 7 children (17%) had DI.…”

“…By far the major ity of urinary tract symptoms in children are due to recur rent urinary infections (UTIs) and/or enuresis. In this group of children the incidence of DI is found to vary from 30 to 78% [2-4], without any signs of neurological disorder being present.The theory has previously been advanced that DI might be the primary cause of urological disorders such as vesicoureteric reflux and enuresis [3,5,6], while other investigators have doubted this [4],The purpose of the present study was to examine the incidence of DI in children with UTI and/or enuresis, and whether DI could be related to irritative bladder symptoms or other pathological conditions in the lower urinary tract. …”

“…By far the major ity of urinary tract symptoms in children are due to recur rent urinary infections (UTIs) and/or enuresis. In this group of children the incidence of DI is found to vary from 30 to 78% [2][3][4], without any signs of neurological disorder being present.…”

Tethered cord syndrome and occult spinal dysraphism

“…35 Urodynamic studies in the setting of incontinence often reveal detrusor hyperreflexia. 38 The occurrence of urinary incontinence has two age-related peaks: it occurs in children less than 10 years of age and in adults between 60 and 80 years of age. 38 There is a wide variety of medical and urological treatments for bladder instability-related urinary incontinence.…”

“…38 The occurrence of urinary incontinence has two age-related peaks: it occurs in children less than 10 years of age and in adults between 60 and 80 years of age. 38 There is a wide variety of medical and urological treatments for bladder instability-related urinary incontinence. In the pediatric and young adult D. E. Warder 6 Neurosurg.…”