The role of bladder instability in pathogenesis of stress-incontinence in women

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After having held urodynamic examination of 700 women complaining of stress-incontinence 292 cases of bladder instability were revealed. Bladder instability is characterized by spontaneous or provoked detrusor reactions of hypertensive type. They appear involuntarily and are followed with simultaneous urethra relaxation. Heavy increase of intravesical pressure along with the decrease of obturative one under physical stress may lead to urine loss in case of abnormal transmission of increased intraperitoneal pressure impulse. Forming of functional cystourethral funnel and relaxation of urethral cross-striated sphincter cause these disturbances. Bladder instability may lead to the development of stress incontinence or complicate its running.

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G. Savitsky

Ott Research Institute of Obstetrics and Gynecology, Russian Academy of Medical Sciences

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2. Fig. 1. Variant of NRM manifested by phasic detrusor contractions occurring with increasing basal tone. Continuous simultaneous urethrocystomanometry in the range of bladder filling from 0 to 150 ml. The upper curve shows a record of bladder pressure (Pves), the middle curve - a record of urethral pressure (profile of urethral pressure when the bladder is empty - dynamics of maximal urethral pressure (Pur)). On the lower curve - a record of the dynamics of obstruction pressure (Pclos).

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3. Fig. 2. A variant of NB, which is characterized by a rapid increase in the basal detrusor tone and a synergistic increase in the obturator pressure. At low degrees of bladder filling, the symptom of tension urinary incontinence is manifested; at medium and high degrees, urine flows as a result of complete urethral relaxation. The symbols are the same as in Fig. 1.

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4. Fig. 3. A pronounced urethral relaxation response to spontaneous contraction of the normotonic detrusor is one of the common variants of PNM in women suffering from frequent daily urination with strong urges. In the interval of bladder filling up to 200 ml there was no urine loss during physical exertion, while further filling of the bladder resulted in the symptom of urinary incontinence during exertion. The markings are the same.

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