Detrusor instability

Peak urinary flow rate <10 mL/s Postvoid residual urine volume >25-50 mL Increased BUN and serum creatinine All of the above signs plus obstructive voiding symptoms and irritative voiding symptoms (signs of detrusor instability)... 

Oxybutynin and tolterodine (Wein et ah, 1991 Appel et ah, 2000), can be more effective than other agents in these conditions, probably because of the high prevalence of detrusor instability (Koff, 1988 Wein et ah, 1991 Sullivan and Abrams, 1999 Appel et ah, 2000 Curran et ah, 2000). Diurnal enuresis and dysfunctional voiding in particular, but even urinary frequency and dysuria, can be very distressing to children and are often publicly obvious. Distress may lead... 

In the urinary tract,flavoxate.oxybutynin, propiverine, tolterodine. trospium and propantheline" are used to relieve muscle spasm accompanying infection in cystitis, and for detrusor instability. 

Oxybutynin is also used for detrusor instability, but antimuscarinic adverse effects may limit its value. 

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. 

Large doses of caffeine cause diuresis. Daily consumption of caffeine citrate increased the mean urinary excretion rate of tubular cells and erythrocytes in volunteers (25). The nephrotoxicity of analgesic antipyretic drug combinations may result from a combined effect, in which aspirin, phenacetin, and caffeine all play a role (SEDA-4, 5). In 10 asymptomatic women and 20 women with confirmed detrusor instability, caffeine caused a significant increase in detrusor pressure on bladder filling in the latter, but no difference in volume at first contraction, height of contraction, or bladder capacity (26). 

Flavoxate is an anticholinergic drug that is used to treat bladder detrusor instability. It can cause aU the adverse effects that would be expected from its anticholinergic action. 

James M, Jackson S, Shepard A, Abrams P. Pure stress leakage symptomatology Is it safe to discount detrusor instability Br J Obstet Gynaecol 1999 106 1255-1258. 

Tapp AJ, Cardozo LD, Versi E, Cooper D. The treatment of detrusor instability in post-menopausal women with oxybutynin chloride A double blind placebo controlled study. Br J Obstet Gynaecol 1990 97 1063-1064. 

Rentzhog L, Stanton SL, Cardozo L, et al. Efficacy and safety of tolterodine in patients with detrusor instability A dose-ranging study. Br J Urol 1998 81 42-48. 

Kelleher CJ, Cardozo LD, Khullar S. A medium term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance. Obstet Gynecol 1997 104 988-993. 

Zorzitto ML, Jewett MAS, Fernie GR, et al. Effectiveness of propantheline bromide in the treatment of geriatric patients with detrusor instability. Neurourol Urodyn 1986 5 133-140. 

Holmes DM, Montz FJ, Stanton SL. Oxybutynin versus propantheline in the management of detrusor instability A patient-regulated variable dose trial. Br J Obstet Gynaecol 1989 96 607-612. 

Castleden CM, Duffin HM, Millar AW. Dicyclomine hydrochloride in detrusor instability A controlled clinical pilot study. J Chn Exp Gerontol 1987 9 265-270. 

Chandra M, Saharia R, Shi Q et al (2002) Giggle incontinence in children a manifestation of detrusor instability. J Urol 168 2184-2187... 

Couillard DR, Webster GD (1995) Detrusor instability. Urol Clin North Am 22 593-612... 

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