The urodynamic assessment of adult enuresis

Urodynamic analysis has revealed a high proportion of uninhibited bladder activity in adult enuresis. There was no associated neurological deficit to explain this abnormality. There was no correlation between the various diurnal symptoms and the presence of uninhibited bladder contractions. Enuresis was associated with obstructive uropathy in only 6 percent of cases. Some evidence has also been presented to support the concepts of ectopic sensory receptors and abnormal sphincter inhibition. A review of the problem of pathogenesis has suggested four main areas of possible abnormality: 1. A sensory lesion producing inadequate or delayed appreciation of bladder activity. 2. Cortical and subcortical dysfunction because of inadequate arousal or defective maturation of subconscious inhibition. 3. A congenital or acquired upper motor neurone lesion causing an uninhibited bladder. 4. A similar or related lesion causing an over-inhibited sphincter. These factors probably always occur in varying combinations. Because of the lack of association between symptoms, signs and objective measurements, there is a strong case for relating diagnosis, prognosis and treatment to urodynamic assessment.