Simultaneous urethrocystometry and hyperactive bladders: A manometric differential diagnosis

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AbstractThe authors reviewed simultaneous urethrocystometry (SUCM) in 96 patients with hyperactive bladders subclassified into four groups (pure detrusor instability, mixed instability, suprasacral spinal lesion, and CNS lesion) and compared the incidence of various urethral parameters. The absence of urethral relaxation before or during the augmentation of the detrusor pressure is the most specific sign of suprasacral spinal lesions. It constitutes what we call passive or tonic dyssynergia. When, at the beginning of SUCM, the maximal closure pressure is > 30 cm H2O, or when a sphincteric contraction is associated with, either before (“kick”) or during (active or clonic dyssynergia) the detrusor contraction, this urethral nonrelaxation is pathognomic of such a spinal lesion. A “kick” is also specific of hyperreflexia but is less constant. On the contrary, in this series and with this technique, an active dyssynergia has no etiological significance; it only reflects the degree of the vesico‐urethral imbalance. This study further supports the importance of the brain stem in controlling and coordinating the vesicosphincteric unit.