UNINHIBITED BLADDER IN CHILDREN
1981 Volume 72 Issue 9 Pages 1145-1163
Details
1981 Volume 72 Issue 9 Pages 1145-1163
Uninhibited bladder in children was studied with regard to its 1) clinical and uroradiographic features, 2) relevancy to non-obstructive VUR and 3) urodynamic aspects.
Results
1) Clinical and uroradiographic features.
a) Incidence. There were in total 84 children who were diagnosed as such at our institution during the last 5 years. When simple enuretic children were excluded, girls comprise more than 70 per cent of them with a peak incidence 5 years and gradually decrease thereafter.
b) The representative symptoms were (both diurnal and nocturnal) urinary incontinence, recurrent urinary infection and/or combination the two, particularly among the girls with urinary infection this was considered to be a primary factor for its recurrence.
c) On voiding cystourethrography DUS like appearance was seen in 24 girls. Further studies suggested that although uninhibited bladder ofter simulate DUS on cystourethrography, DUS itself is a rare entity which is hardly ever responsible for initiation of uninhibited contractions.
2) Its role in the non-obstructive VUR.
81 children with non-obstructive VUR were studied with particular emphasis on their cystometric findings.
a) Study of the incidence of non-obstructive VUR among different age groups indicated the presence of two peaks, one of which was between 3 to 5 years that coincided with the age when uninhibited bladder became symptomatic. When the grading of VUR was compared among the girls in 3 to 7 years of age, it was found that VUR was more severe in those who had uninhibited bladder than in normals.
b) When VUR was associated with uninhibited bladder, its cure is highly expected even in grade IIb to III cases.
c) It is suggested that uninhibited bladder somehow influenced the antireflux mechanism of UVJ, possibly leading to occurrence of VUR and/or its aggravation, to say the least.
3) Urodynamic study in 40 children with combined cystometry, uroflowmetry and sphincter electromyography indicated that there are only a few cases with vesical sphincteric dyssynergia in these children.
