Central nervous system lesion causing urethral instability and urinary incontinence

We report on a girl in whom urinary incontinence developed after surgery for a cerebral arteriovenous fistula. Urodynamic evaluation demonstrated periodic decreases in urethral pressure and external anal sphincter electromyographic activity. These episodes were associated with entry of radiographic contrast material into the urethra and urinary incontinence. Treatment with ephedrine sulfate prevented entry of urine into the proximal urethra and resulted in complete daytime continence, despite persisting urodynamic evidence of urethral and electromyographic abnormalities.