SpringerLink
Log in

The treatment of detrusor instability

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Detrusor instability is a common cause of urinary symptoms, including incontinence. It severely affects the quality of life of thousands of women and at present many of the available treatments lack efficacy, specificity, or are associated with unacceptable side effects. The treatment methods currently in use will be reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Abrams P, Blaivas JG, Stanton SL, Andersen JT. The standardization of terminology of lower urinary tract function recommended by the International Continence Society. Int Urogynecol J 1990; 1:45–58

    Google Scholar 

  2. Female urinary incontinence. Proceedings of an educational course held at the Royal College of Obstetrics & Gynaecology June 1989.

  3. Castleden CM, Duffin HM, et al. Factors influencing outcome in elderly patients with urinary incontinence and detrusor instability. Age and Ageing 1985; 14:303

    Google Scholar 

  4. Kinder RB, Mundy AR. Atropine blockade of nerve-mediated stimulation of the human detrusor. Br J Urol 1985; 57:418–421

    Google Scholar 

  5. Burnstock G, Dumsday B, Smythe A. Atropine resistant excitation of the urinary bladder: the possibility of transmission via nerves releasing a purine nucleotide. Br J Pharmacol 1972; 44:51–61

    Google Scholar 

  6. Gu J, Restorick JM, Blank M et al. Vasoactive intestinal polypeptide in the normal and unstable bladder. Br J Urol 1983; 54:252–555

    Google Scholar 

  7. Sutherst JR, Brown MC. Comparison of single and multichannel cystometry in diagnosing bladder instability. Br Med J 1984, 288:1720

    Google Scholar 

  8. Ingelman-Sundberg A. Partial bladder denervation for detrusor dyssynergia. Clin Obstet Gynecol 1978; 21:797–805

    Google Scholar 

  9. Mundy AR. Long-term results of bladder transection for urge incontinence. Br J Urol 1983; 55:642–644

    Google Scholar 

  10. Torrens MG, Griffith HB. The control of uninhibited bladder by selective sacral neurectomy. Br J Urol 1974; 46:639–644

    Google Scholar 

  11. Helmstein K. Treatment of bladder carcinoma by a hydrostatic pressure technique. Br J Urol 1972; 44:434–450

    Google Scholar 

  12. Dunn M, Smith JC, Ardran GM. Prolonged bladder distension as a treatment of urgency and urge incontinence of urine. Br J Urol 1974; 46:645–652

    Google Scholar 

  13. Pengelly AW, Stephenson TP, Milroy ESG, Whiteside CG, Turner-Warwick RT. Results of prolonged bladder distension as treatment for detrusor instability. Br J Urol 1978; 50:243–245

    Google Scholar 

  14. Turner-Warwick RT, Ashken MH. The functional results of partial subtotal and total cystoplasty with special reference to ureterocaecoplasty, selective sphincterotomy and cystocystoplasty. Br J Urol 1976; 39:3–12

    Google Scholar 

  15. Blaivas JG, Labib KB, Michalik SJ, Zayed AAH. Cystometric response to propantheline in detrusor hyperreflexia: therapeutic implications. J Urol 1980; 124:259–262

    Google Scholar 

  16. Gibaldi M, Grundhofer G. Biopharmaceutic influences on the anticholinergic effect of propantheline. Clin Pharmacol Ther 1975; 18:457–461

    Google Scholar 

  17. Moisey CU, Stephenson TP, Brendler CB. The urodynamic and subjective results of treatment of detrusor instability with oxybutynin chloride. Br J Urol 1980; 52:472–475

    Google Scholar 

  18. Holmes DM, Montz FJ, Stanton SL. Oxybutynin versus propantheline in the treatment of detrusor instability in the female: a patient-regulated variable dose trial. In: Proceedings of the 15th annual meeting of the International Continence Society, London 1985; 63–64

  19. Cardozo LD, Cooper D, Versi E. Oxybutynin chloride in the management of idiopathic detrusor instability. Br Med J 1987; 280:281–282

    Google Scholar 

  20. Baigre RE, Kelleher JP, Fawcett DP, Pengelly AW. Oxybutynin, is it safe? Br J Urol 1988; 62:319–322

    Google Scholar 

  21. Moore KH, Hay DM, Imrie AE, Watson A, Goldstein M. Oxybutynin hydrochloride (3 mg) in the treatment of women with idiopathic detrusor instability. Br J Urol 1990; 66:479–485

    Google Scholar 

  22. Briggs RS, Castleden CM, Asher MJ. The effect of flavoxate on uninhibited detrusor contractions and urinary incontinence in the elderly. J Urol 1980; 123:665–666

    Google Scholar 

  23. Chapple CR, Parkhouse H, Gardener C, Milroy EJG. Doubleblind placebo-controlled, cross-over study of flavoxate in the treatment idiopathic detrusor instability. Br J Urol 1990; 66:491–494

    Google Scholar 

  24. Ulmsten U, Ekman G, Andersson KE. The effect of terodiline treatment in women with motor urge incontinence. Am J Obstet Gynecol 1985; 193:619–622

    Google Scholar 

  25. Tapp AJS, Fall M, Norgaard J et al. A dose-titrated multicentre study of terodiline in the treatment of detrusor instability. In: Proceedings of the 17th annual meeting of the International Continence Society, Bristol, 1987.

  26. Castleden CM, George CF, Renwick AG, Asher MJ. Imipramine, a possible alternative to current therapy for urinary incontinence in the elderly. J Urol 1981; 125:318–320

    Google Scholar 

  27. Cardozo LD. Sex and the bladder. Br Med J 1988; 296:587–588

    Google Scholar 

  28. Monson JP, Richards P. Desmopressin urine concentration test. Br Med J 1978; 1:24

    Google Scholar 

  29. Ramsden PD, Hindmarsh JR, Price DA, Yeates WK, Bowditch JD. DDAVP for adult enuresis — a preliminary report. Br J Urol 1982; 54:256–258

    Google Scholar 

  30. Hilton P, Stanton SL. The use of desmopressin (DDAVP) in nocturnal urine frequency in the female. Br J Urol 1982; 54:252–255

    Google Scholar 

  31. Knudsen UB, Rittig S, Pederen JB, Norgaard JP, Djaarhus JC. Long-term treatment of nocturnal enuresis with desmopressin — influence on urinary output and hematological parameters. Neurourol Urodynam 1989; 8:348–349

    Google Scholar 

  32. Tapp AJS, Cardozo LD. The postmenopausal bladder. Br J Hosp Med 1986; 35:20–23

    Google Scholar 

  33. Fantl JA, Wyman JF, Anderson RL, Matt DW, Bump RC. Postmenopausal urinary incontinence: comparison between non-estrogen supplemented and estrogen supplemented women. Obstet Gynecol 1988; 71:823–828

    Google Scholar 

  34. Jeffcoate TNA, Francis WJA. Urgency incontinence in the female. Am J Obstet Gynecol 1966; 94:604–618

    Google Scholar 

  35. Frewen WK. An objective assessment of the unstable bladder of psychological origin. Br J Urol 1978; 50:246–249

    Google Scholar 

  36. Frewen WK. A reassessment of bladder training in detrusor dysfunction in the female. Br J Urol 1982; 54:372–373

    Google Scholar 

  37. Jarvis GJ. A controlled trial of bladder drill and drug therapy in the management of detrusor instability. Br J Urol 1981; 53:565–566

    Google Scholar 

  38. Holmes DM, Stone AR, Bary PR, Richards CJ, Stephenson TP. Bladder training 3 years on. Br J Urol 1983; 55:660–664

    Google Scholar 

  39. Cardozo LD, Abrams PH, Stanton SL, Feneley RCL. Idiopathic bladder instability treated by biofeedback. Br J Urol 1978; 50:521–523

    Google Scholar 

  40. Holmes DM, Plevnik S, Stanton SL. Bladder neck electric conductivity in female urinary incontinence and urge incontinence. Br J Obstet Gynaecol 1989; 96:816–820

    Google Scholar 

  41. Freeman RM, Baxby K. Hypnotherapy for incontinence caused by the unstable bladder. Br Med J 1982; 284:1831–1834

    Google Scholar 

  42. Philp T, Shah PJR, Worth PHL. Acupuncture in the treatment of bladder instability. Br J Urol 1988; 61:490–493

    Google Scholar 

  43. Klarskov P. Enkephalin inhibits presynaptically the contractility of urinary tract smooth muscle. Br J Urol 1987; 59:31–35

    Google Scholar 

  44. Murray KH, Feneley RCL. Endorphins — a role in lower urinary tract function? The effect of opioid blockade on the detrusor and urethral sphincter mechanisms. Br J Urol 1982; 54:638–640

    Google Scholar 

  45. Pigne A, Degausac C, Nyssen C, Barrat J. Acupuncture and the unstable bladder. In: Proceedings of the 15th meeting of the International Continence Society, 1985.

  46. Gibson JS, Pardley J, Neville J. Infrared low-power laser therapy on acupuncture points for treatment of the unstable bladder. In: Read by titles. The 20th meeting of the International Continence Society, 1990.

  47. Plevnik S, Janez J, Vrtacnik P, Trasinar B, Vodusek DB. Short-term electrical stimulation: home treatment for urinary incontinence. World J Urol 1986; 4:24–26

    Google Scholar 

  48. Warrel DW. Vaginal denervation of the bladder nerve supply. Urol Int 1977; 32:114–116

    Google Scholar 

  49. Lucas MG, Thomas DG. Endoscopic bladder transection for detrusor instability. Br J Urol 1987; 59:526–528

    Google Scholar 

  50. Higson RH, Smith JC, Whelan P. Bladder rupture: an acceptable complication of distension therapy? Br J Urol 1978; 50:529–534

    Google Scholar 

  51. Ewing R, Bultitude MI, Shuttleworth KED. Subtrigonal phenol injection for urge incontinence secondary to detrusor instability in females. Br J Urol 1982; 54:689–692

    Google Scholar 

  52. Blackford W, Murray K, Stephenson TP, Mundy AR. Results of transvesical infiltration of the pelvis with phenol in 116 patients. Br J Urol 1984; 56:647–649

    Google Scholar 

  53. Cameron-Strange A, Millard RJ. Management of refractory detrusor instability by transvesical phenol injection. Br J Urol 1988; 62:323–325

    Google Scholar 

  54. Rosenbaum TP, Shah PJR, Worth PHL. Transtrigonal phenol: the end of an era? Neurourol Urodynam 1988; 7:294–295

    Google Scholar 

  55. Wall LL, Stanton S. Transvesical phenol injection of pelvic nerve plexuses in females with refractory urge incontinence. Br J Urol 1989; 63:465–468

    Google Scholar 

  56. Bramble FJ. The treatment of adult enuresis and urge incontinence by enterocystoplasty. Br J Urol 1982; 54:693–696

    Google Scholar 

  57. Mundy AR, Stephenson TP. ‘Clam’ ileocystoplasty for the treatment of refractory urge incontinence. Br J Urol 1985; 57:641–646

    Google Scholar 

  58. Rosenbaum TP, Shah PJR, Rose GA, Lloyd-Davis RW. Cranberry juice helps the problem of mucus production in enterouroplastics. Neurourol Urodynam 1989; 8:344–345

    Google Scholar 

  59. McRae P, Murray KH, Nurse DE, Stephenson TP, Mundy AR. Clam enterocystoplasty in the neuropathic bladder. Br J Urol 1987; 60:523–525

    Google Scholar 

  60. Nurse DE, Mundy AR. Cystoplasty infection and cancer. Neurourol Urodynam 1989; 8:343–344

    Google Scholar 

  61. Stone AR, Davis N, Stephenson TP. Cancer associated with augmentation cystoplasty. Br J Urol 1987; 60:236–238

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research Fellow in Urodynamics, King's College Hospital, Denmark Hill, SE5, London, UK

    B. G. Wise

  2. Department of Obstetrics and Gynaecology, King's College Hospital, London, UK

    L. D. Cardozo

Authors
  1. B. G. Wise
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. D. Cardozo
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wise, B.G., Cardozo, L.D. The treatment of detrusor instability. Int Urogynecol J 3, 229–237 (1992). https://doi.org/10.1007/BF00455008

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00455008

Keywords

Search

Navigation