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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.17

ISSN Druckformat: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v11.i1.20
27 pages

Detrusor Instability in the Female: Controversies in Diagnosis, Etiology, and Management

Kate H. Moore
The Pelvic Floor Unit and the Department of Obstetrics and Gynecology of the University of New South Wales; The Pitney Clinical Sciences Building, St. George Hospital, Kogarah, Sydney, New South Wales 2217, Australia


Detrasor instability gives rise to disabling symptoms of urgency, frequency, nocturia, and urge incontinence. This review provides a critical analysis of the methods used to diagnose the condition and illustrates some of the pitfalls of conventional cystometry testing. The value of ambulatory urodynamic testing is also considered. The concept that detrusor contractions may occur in asymptomatic subjects is criticized.
Recent insights into the etiology of this condition are provided, including new evidence regarding the cerebral control of micturition: the debate as to whether the detrusor muscle or its innervation may be at fault is summarized.
Controversial aspects of management, such as the value of first-line therapy with anticholinergic drugs in those with an intact cerebral cortex, are reviewed. Recently developed nonsurgical treatments are described, and the mode of action of surgical treatment is considered.
While advances have been made in our understanding of the diagnosis, etiology, and treatment of detrusor instability have been made in the last 2 decades, much further work is needed.