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The unstable bladder.

A R Mundy

    Clinics in Obstetrics and Gynaecology
    |June 1, 1985
    PubMed
    Summary
    This summary is machine-generated.

    Urinary urgency due to unstable bladder (UB) can be managed with bladder drill or oxybutynin. Surgical options like phenol injections or ileocystoplasty offer solutions when conservative treatments fail.

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    Area of Science:

    • Urology
    • Clinical Medicine

    Background:

    • Unstable bladder (UB) is a prevalent clinical issue with unclear origins.
    • In vitro studies reveal distinct behavioral and pharmacological responses in unstable human detrusor muscle compared to normal detrusor.
    • The primary urodynamic abnormality involves involuntary detrusor contractions, leading to urgency.

    Purpose of the Study:

    • To outline a management strategy for unstable bladder.
    • To guide empirical treatment initiation based on voiding charts.
    • To reserve extensive urodynamic investigations for non-responders.

    Main Methods:

    • Exclusion of outflow obstruction as a contributing factor.
    • Utilizing a 48-hour voided volume chart for initial assessment.
    • Employing bladder drill for minimal urodynamic dysfunction.

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  • Administering oxybutynin and other medications as needed.
  • Considering transvesical pelvic plexus phenol injection for refractory cases.
  • Evaluating 'clam' ileocystoplasty as a curative option for persistent cases or when phenol is contraindicated.

    • Main Results:

    • Involuntary detrusor contractions are the hallmark of unstable bladder, causing urgency.
    • Symptom severity depends on bladder capacity and the ability to suppress contractions.
    • Conservative treatments like bladder drill and oxybutynin are effective for many patients.
    • Phenol injections and ileocystoplasty provide successful outcomes for refractory cases.

    Conclusions:

    • Empirical treatment for unstable bladder can commence based on voiding chart data after excluding obstruction.
    • Bladder drill is the first-line therapy for minimal dysfunction, followed by pharmacotherapy.
    • Invasive procedures like phenol injection and ileocystoplasty offer effective solutions for treatment-resistant unstable bladder.