The unstable detrusor

Abstract

The unstable detrusor (detrusor instability), a common condition in men and women, causes significant morbidity in sufferers and a great financial expense to health care providers. The condition is associated with symptoms of urinary frequency, urgency and urge incontinence. The embarrassing nature of these symptoms means patients are often reluctant to seek medical help and as a consequence there is under-reporting. Epidemiological studies are difficult to perform but appear to show that incidence increases with age and that the unstable detrusor is the commonest cause of male urinary incontinence. The aetiology is still much debated with reasoned arguments for both neurogenic and myogenic causes, though in truth, the likely explanation is multifactorial rather than a single underlying pathological process. The diagnosis can only be made on urodynamic testing. Before deciding on suitable treatment, the clinician must assess the disease severity and also its impact on patient quality of life. This is because perceived improvement in patient quality of life must outweigh any potential morbidity associated with treatment. Pharmacotherapy is based on blocking bladder muscarinic receptors. Unfortunately, no treatment is bladder specific and therefore most drug therapies have unwanted systemic anticholinergic side effects. Surgical treatment often involves a degree of bladder denervation to reduce bladder activity. This can consequently produce voiding difficulties which necessitate patients to self-catheterise on a longterm basis.