Sphincteric incontinence is the most common urodynamic finding in patients with post-radical prostatectomy incontinence, although other findings may coexist. The most accurate diagnosis is attained when all objective measures are put in perspective with the clinical setting.

The International Continence Society (ICS) de®nes overactive detrusor as ``one that is shown objectively to contract during the ®lling phase while the patient is attempting to inhibit micturition.'' The aim of the present study was to assess whether instructing the patient neither to try void nor to inhibit micturition during ®lling cystometry may improve the detection rate of involuntary detrusor contractions (IDCs). Forty-two consecutive patients (mean age 65 AE 13.5 years), referred for urodynamic evaluation of persistent irritative lower urinary tract symptoms were prospectively enrolled. All patients were presumed, by history, to have IDCs. Cystometry was performed twice at the same session, each time by using randomly different instructions: Method 1, patients were instructed to try to inhibit micturition during bladder ®lling; and Method 2, patients were instructed to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner. The occurrence, as well as the urodynamic characteristics of IDCs, were analyzed separately and compared between the two ®lling methods. Method 1 identi®ed only 20 cases of IDCs, while Method 2 identi®ed 27 cases (48 versus 64% of the study population, respectively; P 0.02). Analysis of urodynamic characteristics revealed a clear trend of reduced bladder volume at which IDCs occurred when patients were instructed to neither try to void nor to inhibit micturition during bladder ®lling; however, statistical signi®cance was not established (189 AE 122 versus 240 AE 149 mL, respectively; P 0.13). All other urodynamic characteristics of IDCs were similar in both methods. In conclusion, better detection rates of IDCs were achieved by instructing the patient to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner, during ®lling cystometry. If the patient is instructed to inhibit micturition during bladder ®llingÐabout 26% of the IDC cases are misdiagnosed. Neurourol. Urodynam. 20:141±145, 2001.

The International Continence Society (ICS) de®nes overactive detrusor as ``one that is shown objectively to contract during the ®lling phase while the patient is attempting to inhibit micturition.'' The aim of the present study was to assess whether instructing the patient neither to try void nor to inhibit micturition during ®lling cystometry may improve the detection rate of involuntary detrusor contractions (IDCs). Forty-two consecutive patients (mean age 65 AE 13.5 years), referred for urodynamic evaluation of persistent irritative lower urinary tract symptoms were prospectively enrolled. All patients were presumed, by history, to have IDCs. Cystometry was performed twice at the same session, each time by using randomly different instructions: Method 1, patients were instructed to try to inhibit micturition during bladder ®lling; and Method 2, patients were instructed to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner. The occurrence, as well as the urodynamic characteristics of IDCs, were analyzed separately and compared between the two ®lling methods. Method 1 identi®ed only 20 cases of IDCs, while Method 2 identi®ed 27 cases (48 versus 64% of the study population, respectively; P 0.02). Analysis of urodynamic characteristics revealed a clear trend of reduced bladder volume at which IDCs occurred when patients were instructed to neither try to void nor to inhibit micturition during bladder ®lling; however, statistical signi®cance was not established (189 AE 122 versus 240 AE 149 mL, respectively; P 0.13). All other urodynamic characteristics of IDCs were similar in both methods. In conclusion, better detection rates of IDCs were achieved by instructing the patient to neither try to void nor try to inhibit micturition, but simply report his or her sensations to the examiner, during ®lling cystometry. If the patient is instructed to inhibit micturition during bladder ®llingÐabout 26% of the IDC cases are misdiagnosed. Neurourol. Urodynam. 20:141±145, 2001.

Sphincteric incontinence is the most common urodynamic finding in patients with post-radical prostatectomy incontinence, although other findings may coexist. The most accurate diagnosis is attained when all objective measures are put in perspective with the clinical setting.

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