Overactivity of the integral storage and voiding reflexes in the juvenile urinary incontinence syndrome

The physiologic importance of 12 integral storage and voiding reflexes has not been generally recognized and appreciated by clinicians. Pathologic overactivity of reflexes No. 9 and No. 10, the urethrodetrusor facilitatory reflexes, appears to be a very common factor in the etiology of the juvenile incontinence syndrome. Mild but urodynamically significant obstructive lesions of the distal urethra are a common predisposing factor to chronic urethritis and are potentially remediable by simple surgical procedures. Cystometric as well as symptomatic improvement is commonly observed postoperatively. The micturition reflex is extremely complex. Its excitability is dependent upon the balance of multiple vectors of both facilitatory and inhibitory influence from many sources, peripheral as well as central. The popular clinical concept of "uninhibited neurogenic bladder," based on the cystometrogram, is naive and simplistic. It deserves to be replaced by the term "unstable bladder" which acknowledges the neurologic and urologic complexities of micturition reflex instability and introduces no erroneous connotations as to the cause and potential treatability of an incontinence condition.