Children With Unstable Bladder: Clinical and Urodynamic Observation

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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 < 10 yr old and patients 60-80 yr old. Sex was not significant in the children but men predominated in the adults. There were 68 children < 15 yr old with the chief complaints of enuresis (54%), urge incontinence (41%) and fever (25%). 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%). Several postures, characteristically used to resist unheralded urgency and to prevent urine from leaking, were noted. The main therapeutic regimen consisted of anticholinergics with or without antimicrobials. Several children underwent surgical intervention. Once the antireflux operation was performed, follow-up with anticholinergics was of primary importance. The unstable bladders of 63 of the 68 children (93%) have been controlled satisfactorily. The etiology of bladder instability is discussed for both groups of patients.