Signs of Compensation and Decompensation in Bladder Outlet Obstruction

Abstract

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.

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

“…There seem to be two major points of view: (1) that DI appears secondary to pathological changes in the lower urinary tract such as recurrent uri nary tract infections (UTIs) or infravesical obstruction [1,2], or (2) that DI is caused primarily by delayed maturity of the nervous system which controls the micturition reflex [3] and that pathological conditions such as UTI and vesicoureteric reflux appear secondarily to DI [4,5], Irrespective of which of the theories applies, patients with DI will have short intervals where the intravesical pressure becomes very high, which will partly inhibit the immunological defence in the bladder [6] and partly influence the upper urinary tract in patients with vesi coureteric reflux [3][4][5], Therefore, treatment of children with urinary tract symptoms, in whom DI has been revealed, should pri marily be aimed/at eliminating the tendency to instability of the bladder.…”