Bladder instability and upper renal tract damage

Bladder instability simulating neurogenic bladder disease is one of the commonest causes of dysfunctional voiding in children. We studied 100 cases with such problem over a five-year period; the peak age incidence was between 4-8 years. The gender distribution was 3:2 with female preponderence. Urgency and urge incontinence occurred in 80% of cases, recurrent acute cystitis in 50%, characteristic-holding postures in 15% and nocturnal enuresis in 40%. Variable degrees of bladder wall thickening and significant residual urine were seen on ultrasound examination. The patients were given anticholinergic therapy and antibiotic prophylaxis. All the patients went into complete remission within five years, many of them earlier. None needed surgical intervention although few patients had undergone surgical vesicoscopy and urethral dilation before they were referred to us. We conclude that recognition of the children with bladder instability is paramount to successful management and this will help to avoid upper renal damage and reduce the discomfort from unnecessary investigations and surgical procedures.