Detrusor instability in children

In routine cystometric investigation of children complaining of enuresis and/or recurrent urinary tract infections, the incidence of apparent detrusor instability is high and only very weakly related to symptoms. It is not reproducible in repeated tests and is provoked by anxiety associated with the examination. By performing three successive cystometries at one sitting, while the child sits watching TV, we are able to reduce the anxiety and to identify a hard core of detrusors that are consistently unstable in all three tests. Consistent instability is related to symptoms. Among nocturnally enuretic boys, it is much more common in those who have additional daytime symptoms. Among girls, it is significantly more common among those complaining of enuresis than among those complaining of recurrent urinary tract infections. These results suggest that there are two types of enuresis, in only one of which detrusor instability is a contributory factor, and that detrusor instability is not associated with a history of repeated urinary tract infections. They show also that clinically significant information can be obtained by a simple cystometric method that can easily be carried out on an out‐patient basis.