History of cystometry

Abstract

Looking back on the changes in the conceptualization of micturition and the development of cystometry, it is reasonable to arrive at several conclusions. Considering their poor technical equipment, Budge's and Goltz's neurophysiologic observations in the 19th century were impressive. The pontine center for micturition, found by Budge, was later confirmed, by Barrington, to have a facilitating and coordinating function. Goltz's demonstration that micturition could be partially accomplished by a spinal reflex was unfortunately given too little attention by clinicians practicing cystometry in the beginning of this century. Dubois' careful pioneering investigations of bladder pressure, and Mosso and Pellacani's studies in bladder motility were outstanding. From Born's and Genouville's contributions, continuously recordable filling cystometry was developed as early as the end of the last century. However, due to a fixation on "bladder tone" and the concept of "crossed innervation" by succeeding investigators, development of cystometry was at a standstill for almost forty years before gradually attaining its modern interpretation. Compared to our century, it is striking how carefully all investigators from the 19th century cited each other and knew about each other's work. This was possible, in spite of poor communication, because of the small number of investigators involved in studies of bladder function. Although cystometry today is quite informative in many cases, two main points, the presence of detrusor contraction reflex and the patient's capacity to suppress its occurrence, are still highly dependent on the technique used and the subject's cooperation. The more complicated urodynamic investigations flourishing during the last fifteen years have been met with the same uncertainty as the preceding ones since they are partially or completely dependent on patient compliance. Frequently, findings in the laboratory do not relate to the clinical situation. Hopefully, future development of monitoring of bladder-urethral function and the use of neurophysiologic electrodiagnostic methods will reduce these difficulties. The authors believe that modern cystometry began in the 1950s, and that discussion of this period and up to the present is more appropriately the subject of a review on modern methodologies. Further, it is difficult to place modern technology and investigators in historical perspective when events are evolving.