The management of detrusor instability

The term detrusor instability was coined by Bates to describe involuntary detrusor contractions occurring during bladder filing. It should be distinguished from hyperreflexia, where the abnormal activity occurs as a consequence of known neurologic dysfunction. Detrusor instability can be associated with outflow obstruction and can co-exist with emale stress incontinence, in all other cases no obvious etiological factor can be elicited. Detrusor instability can only be accurately identified urodynamically. Management is directed at removing any associated problems and improving blader storage function. This chapter discusses management modalities ranging from simple biofeedback techniques to surgical reconstruction. The relative indication for these treatment techniques and their result are discussed.