Unstable bladder

The prevalence of nonneurogenic bladder-sphincter dysfunction ( voiding dysfunction ) in children is high. One or more symptoms of disturbed bladder function were reported in up to 26% of children. Overactive bladder (unstable bladder) turned out to be the most common dysfunction. 

The causes of enuresis are always functional the causes of incontinence may be organic or functional, but are mostly functional (Kelleher 1997). Functional causes can be divided as mentioned above in this chapter into overactive bladder (unstable bladder) and dysfunctional voiding in particular. 

Brading K+-ATP channels are marvellous they stop all of the unstable contractions in the bladder straight off. The only problem is that they do everything else as well. 

Arii T, Ohyanagi M, Shibuya J, Iwasaki T 1999 Increased function of the voltage-dependent calcium channels, without increase of Ca2+ release from the sarcoplasmic reticulum in the arterioles of spontaneous hypertensive rats. Am J Hypertens 12 1236-1242 Attree O, Olivos IM, Okabe I et al 1992 The Lowe s oculocerebrorenal syndrome gene encodes a protein highly homologous to inositol polyphosphate-5-phosphatase. Nature 358 239-242 Brading AF, Turner WH 1994 The unstable bladder towards a common mechanism. Br J Urol 73 3-8... 

Fluconazole is very effective in the treatment of infections with most Candida spp. Thrush in the end-stage AIDS patient, often refractory to nystatin, clotrimazole, and ketoconazole, can usually be suppressed with oral fluconazole. AIDS patients with esophageal candidiasis also usually respond to fluconazole. A single 150-mg dose has been shown to be effective treatment for vaginal candidiasis. A 3-day course of oral fluconazole is effective treatment for Candida urinary tract infection and is more convenient than amphotericin B bladder irrigation. Preliminary findings suggest that Candida endophthalmitis can be successfully treated with fluconazole. Stable nonneutropenic patients with candidemia can be adequately treated with fluconazole, but unstable, immunosuppressed patients should initially receive... 

Contraindications Bladder neck obstruction due to prostatic hypertrophy, cardiospasm, intestinal atony, myasthenia gravis in those not treated with neostigmine, narrow-angle glaucoma, obstructive disease of the GI tract, paralytic ileus, severe ulcerative colitis, tachycardia secondary to cardiac insufficiency or thyrotoxicosis, toxic megacolon, unstable cardiovascular status in acute hemorrhage... 

Urinary frequency and dysuria may be caused by high detrusor muscle tone or unstable neuromuscular function, but with good sensation and normal or excessive sphincter control. Extreme bladder sensitiv-... 

Flavoxate (Urispas) is used for urinary frequency, tenesmus and urgency incontinence because it increases bladder capacity and reduces unstable detrusor contractions (see p. 543). 

Unstable bladder or detrusor instability, characterised by uninhibited, unstable contractions of the detrusor which may be of unknown aetiology or secondary to an upper motor neuron lesion or bladder neck obstruction. 

Malone-Lee JG. The efficacy, tolerability and safety profile of tolterodine in the treatment of overactive/unstable bladder. Rev Contemp Pharmacother 2000 11 (29 2). 

Fucus is highly adapted for its unstable, shallow water environment. Fronds are equipped with air bladders that keep the plant afloat when the tide comes in. The stipes and fronds synthesize a gel-like material, alginate, which improves flexibility, allowing the plant to move with the flow of water. Alginate also conserves moisture, preventing desiccation when the tide is out. 

Gross hematuria when tissue growth exceeds its blood supply Overflow urinary incontinence or unstable bladder Recurrent urinary tract infection that results from urinary stasis Bladder diverticula Bladder stones... 

The three Aurora kinases play multiple roles in cell cycle progression and cell proliferation and may be useful targets for cancer therapy. Also, Aurora kinases are often overexpressed in cancer. For example, Aurora A is overexpressed in breast cancer, and is found on chromosomal region (20ql3.2), which is commonly amplified in tumors. Ectopic overexpression of Aurora A in Rati and NIH/3T3 cells gives rise to genetically unstable aneuploid cells with multiple centrosomes that are capable of forming tumors when injected into nude mice. Also, amplification and overexpression of Aurora A is associated with aneuploidy in human bladder cancer tissues. 

This is the most severe type and results in total sacroiliac joint disruption. Features of the Type 1 and 2 pattern may be present. There is widening of the sacroiliac joint and there is diastasis both posteriorly as well as anteriorly due to the posterior sacroiliac ligament rupture. On clinical examination, the hemi-pelvis is unstable in all directions of force and typically requires operative stabilisation. It is possible for the sacroiliac joint to remain intact but there is fracture of the sacroiliac bone. Complications include bladder rupture, and vascular injury (Figs. 12.8,12.9). 

Flow should be continuous until bladder repletion is attained. Interruption or back flow can be due to contractions of the detrusor muscle when an unstable bladder is present (see Chap. 14). Spot films are taken during filling in order to detect passive reflux. 

Potter R, Kopp W, Klein E et al (1986) Unstable bladder in children functional evaluation by modified voiding cystourethrography. Radiology 161 811-813... 

Fig.1.3.3. IRC recurrent urinary tract infection in a 4-year-old girl. Reflux into right kidney is noted on this indirect radionuclide cystogram despite the fact that there was no micturition. This suggests the diagnosis of an unstable bladder that was confirmed on further investigation...

A broad spectrum of terms such as nonneuro-pathic vesicourethral dysfunction (Koff 1984), overactivity of the bladder and striated urethral muscle (Van Gool et al. 1984), nonneuropathic or nonneurogenic bladder-sphincter dysfunction (Hoebeke et al. 1999), dysfunctional bladder (Hinman 1986), unstable bladder (Koff 1982), nonneurogenic neurogenic bladder (Allen 1977) and Hinman syndrome (Hinman 1986) is still in use for sometimes overlapping patterns of nonneurogenic bladder-sphincter dysfunction. 

Bauer (1992) grouped into primarily unstable bladder (small capacity, hypertonic bladders and detrusor hyperreflexia), infrequent voiding associated with large-capacity bladders (lazy bladder syndrome) and psychogenic nonneuropathic bladder (Hinman syndrome). 

The classification of the International Children s Continence Society should be used to eliminate confusion, to facilitate and enable comparative research and metaanalyses. This classification recognizes two main dysfunctions overactive bladder or unstable bladder (urge syndrome) and dysfunctional voiding. The common denominator of lower urinary tract dysfunction is bladder sphincter discoordination leading to chronic high intravesical pressure with resulting negative consequences for the urinary tract. 

Bauer et al. (1980) found that the majority of children with urinary tract dysfunction had unstable bladder and only a small number had the severest type of dysfunction, which is called nonneurogenic neurogenic bladder (Allen 1977). 

ScHULMAN et al. (1999) described unstable bladder or urge syndrome in 52% of cases of nonneurogenic bladder-sphincter dysfunction followed by dysfunctional voiding in 25%. Himsl and Hurwitz (1991) state as well that the underlying problem in the great majority of children with functional disorders of the lower urinary tract is unstable bladder. 

The study by Mayo and Burns (1990) and the publication of Hoebeke et al. (1999) show that the number of cases with unstable bladder is around 60%. Passerini-Glazel et al. (1992) describe a rate of unstable bladder of 90% in children with nonneurogenic bladder-sphincter dysfunction. In 156 children with daytime incontinence, Van Gool (1992a) found unstable bladder in 53% and dysfunctional voiding in 59%. Weerasinghe and Malone (1993) reported unstable bladder in 54% and dysfunctional voiding in 3.5%. 

In a study on the utility of video-urodynamics in children with UTI and nonneurogenic bladder sphincter-dysfunction. Glazier et al. (1997) also found a majority of cases with unstable bladder and only 30% of patients with dysfunctional voiding. 

Hoebeke et al. (2001) in a publication about 1,000 videourodynamic studies in children with nonneurogenic bladder dysfunction found urge syndrome (overactive bladder or unstable bladder) in 58% (male female ratio 58 42), dysfunctional voiding (overactivity of the external urethral sphincter) in 32% (male female ratio 49 51) and lazy bladder in 4% (male female ratio 20 80). Furthermore, he found that the age distribution provided evidence against a dysfunction sequence as mentioned above. 

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