Cystometric subtypes of bladder overactivity: A retrospective analysis of 501 patients

Abstract

Three subtypes of bladder overactivity were recognized in a retrospective study of 501 patients. The subdivision was based on cystometry and clinical findings and includes the following diagnostic groups: 1) Phasic detrusor instability, characterized by phasic bladder contractions during the filling phase, with normal or increased bladder sensation; 2) uninhibited overactive bladder, characterized by impaired perception of bladder fullness, an uninhibited micturition reflex and a positive ice-water test; 3) Spinal detrusor hyperreflexia in upper motor neuron lesion, complete or incomplete. The largest group of patients had signs and symptoms consistent with the diagnosis of uninhibited over active bladder (47%). Phasic detrusor instability was found in 15% of the patients and 28% had spinal detrusor hyperreflexia. The remaining 10% had an atypical or mixed pattern of symptoms. There were large, significant differences between the groups with respect to several cystometric parameters, such as the occurrence of phasic detrusor contractions, abnormal perception of bladder fullness, voluntary inhibition of micturition and the outcome of the ice-water test. The proposed subdivision of bladder overactivity is simple, clinically relevant and based on parameters readily available in standard cystometry.