The Urodynamic Assessment of Adult Enuresis

Abstract

Urodynamic analysis has revealed a high proportion of uninhibited bladder activity in adult enuresis. There was no associated neurological deficit to explain this abnormality. There was no correlation between the various diurnal symptoms and the presence of uninhibited bladder contractions. Enuresis was associated with obstructive uropathy in only 6 percent of cases. Some evidence has also been presented to support the concepts of ectopic sensory receptors and abnormal sphincter inhibition. A review of the problem of pathogenesis has suggested four main areas of possible abnormality: 1. A sensory lesion producing inadequate or delayed appreciation of bladder activity. 2. Cortical and subcortical dysfunction because of inadequate arousal or defective maturation of subconscious inhibition. 3. A congenital or acquired upper motor neurone lesion causing an uninhibited bladder. 4. A similar or related lesion causing an over-inhibited sphincter. These factors probably always occur in varying combinations. Because of the lack of association between symptoms, signs and objective measurements, there is a strong case for relating diagnosis, prognosis and treatment to urodynamic assessment.

Ureteric Jet Doppler Waveform and Bladder Wall Thickness in Children With Nocturnal Enuresis

“…In this study, over half of the enuretic children had significantly thickened bladder wall (Ͼ0.5 cm). Bladder wall thickness could be one of the features of detrusor immaturity as suggested in previous studies (13,19,31). This was further supported by the strong association found between thickened bladder wall with high detrusor pressure, unstable bladder contraction, and dyssynergia in this study.…”

“…A number of studies have suggested presence of detrusor overactivity in enuretics (7,13,28). Watanabe and Azuma (29) found enuretics had more unstable contractions at night than at daytime.…”

“…In long-standing detrusor overactivity, the bladder wall may become thicker, trabeculated, and irregular in contour (13,19). Tibballs and De Bruyn (31) found that mean bladder wall thickness in normal boys was 0.306 cm and in normal girls was 0.273 cm.…”

“…Suggested etiologies have included psychological and behavioral disturbance (3), lack of arousal from sleep (4 -7), overproduction of nocturnal urine (8 -12), and delayed maturation of neural pathways and bladder abnormalities (6,(13)(14)(15)(16).…”

Is the Sensory Innervation Disturbed in the Lower Urinary Tract of Children with Bed-Wetting?

“…During daytime, such disturbance might cause a late occurrence of the desire to void, 'late warning hypesthetic urgency' [10]. Others [11][12][13] described that in patients with bed-wet ting a pathological tension-reception might exist which might in turn be responsible for a deficient sensory stimu lation during sleep.…”