Detrusor/sphincter dyssynergia in neurologically normal children

Abstract

AbstractFor 143 boys and girls without overt neuropathy, the occurrence of urethral overactivity during voiding (detrusorkphincter dyssynergia) has been investigated in three cystometrically recorded micturitions and a free‐flow measurement. The following aspects have been statistically examined for their reproducibility and consistency in reflecting urethral over‐activity: the pressure/flow relationship, the pelvic‐floor EMG, residual urine, and the freeflow curve. Any single aspect, or any single micturition (even the free‐flow measurement), suggests an unrealistically high incidence of “dyssynergia.” By combining them, however, we have developed a concept of consistent urethral overactivity, which is associated with residual urine, appears to be clinically significant, and has an incidence of 19% in our material. Consistent urethral overactivity has a significantly higher incidence (67%) in children with upper‐tract disease on both sides, suggesting a causative role. In girls, there is a spectrum of dysfunction, ranging from a more serious type, reflected in the presence of residual urine and of consistent urethral overactivity, to a relatively trivial type, without residual urine, associated principally with an abnormally high EMG during voiding and with a history of urinary tract infections. In our material, there is no association between urethral overactivity during voiding and detrusor instability during bladder filling, suggesting that these are two unrelated findings and not two aspects of a single syndrome.