[The symptomatology and consequences of bladder hyperreflectivity (author's transl)]

Approaching the currently widely studied field of the pathology of vesical inhibition, the authors review the symptomatology and consequences of vesical hyperreflectivity. They begin with clinical definitions of frequency and urgency and then attempt to draw out the limits of the clinical picture involved in incontinence because of urgency (ineffective contraction of the striate sphincter, impossibility of inhibition of vesical contraction, sudden loss of urethral tone as a result of urethral instability), and that of reflex incontinence, true enuresis. They then describe the various cystometric aspects of such forms of vesical instability, finishing with an area about which there is still little knowledge but certainly fundamental: development of bladder hypertrophy and the possible explanation of infectious complications or even vesico-ureteric reflux by simple vesical hyperreflectivity. In fact, each occlusion of the sphincter system in the presence of sudden increased vesical contraction of a non-inhibited bladder provokes a minor episode of transient complete vesical retention. Accumulation of such accidents results in severe bladder hypertrophy with increased tone. Trabeculation, diverticulation, aggravation of infection and the development of para-urethral diverticula responsible for reflux underline the grave nature of the problems affecting certain patients with vesical hyper-reflectivity. This occurs even in the absence of dyssynergism and in the absence of typical neurological disturbances. There is thus the possibility of a neurogenic bladder and the consequences of a neurogenic bladder without necessarily any organic cervico-urethral obstruction.