Abstract
Detrusor instability has for years been thought to be due to a primary bladder pathology in 90% of cases. The remaining 10% were attributed to neurologic disorders. The simultaneous measurement of urethral and bladder pressures in patients with detrusor instability revealed two different patterns. The first was characterized by uninhibited bladder contractions followed by urethral relaxation. The second consisted of detrusor contraction preceded by urethral relaxation. The presence of involuntary urethral pressure changes exceeding 15 cmH2O was defined as urethral instability. These observations have important therapeutic implications. Bladder instability secondary to an unstable urethra does not respond to anticholinergic therapy as well as primary detrusor instability. Better results are obtained by increasing the tone of the urethral sphincter with alpha-adrenergic drugs. Therefore, it is important to identify the chronological sequence of bladder and urethral pressure changes, in order to plan adequate therapy for patients with detrusor instability.
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