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The management of detrusor instability
1Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710.
Clinical Obstetrics and Gynecology
|June 1, 1990
Summary
Detrusor instability, a cause of urinary urgency and incontinence, can be managed with behavioral techniques like bladder drill and medications such as oxybutynin chloride. Refractory cases may require advanced treatments like augmentation cystoplasty.
Area of Science:
- Urology
- Urodynamics
- Pharmacology
Background:
- Detrusor instability is a urodynamic diagnosis characterized by involuntary bladder contractions during the filling phase.
- It is a common cause of urgency, frequency, nocturia, and urge incontinence.
- It can also mimic or coexist with stress incontinence, necessitating its exclusion before surgical intervention.
Purpose of the Study:
- To review the diagnosis and management of detrusor instability.
- To discuss various therapeutic options, including behavioral, pharmacologic, and surgical interventions.
- To highlight the importance of treating detrusor instability before addressing stress incontinence.
Main Methods:
- Review of existing literature on detrusor instability diagnosis and treatment.
- Discussion of urodynamic findings (cystometrogram).
- Evaluation of pharmacologic agents (oxybutynin chloride, propantheline bromide, imipramine, emepronium bromide, flavoxate hydrochloride, terodiline hydrochloride, prostaglandin synthetase inhibitors) and behavioral therapies (bladder drill).
Main Results:
- Bladder drill combined with oxybutynin chloride is a preferred initial approach.
- Propantheline bromide and imipramine are effective pharmacologic options, with imipramine useful for nocturia.
- Terodiline hydrochloride is anticipated to improve treatment options; prostaglandin inhibitors may help perimenstrual symptoms.
Conclusions:
- Detrusor instability requires objective urodynamic diagnosis and should be managed before surgical correction of stress incontinence.
- A stepwise approach involving behavioral therapy, pharmacologic agents, and potentially electrical stimulation or surgery (augmentation cystoplasty for refractory cases) is recommended.
- Effective management strategies are available, ranging from conservative measures to advanced surgical procedures for severe cases.