100 UNSTABLE BLADDERS

Objective: To investigate the correlation between presenting symptoms and cystometric data in patients with urodynamically proven detrusor i nstability. Methods: A retrospective review was conducted of standardi zed urodynamic data bases and cystometrograms from the gynecologic uro dynamics laboratories at Duke University Medical Center, Durham, North Carolina, and Grady Memorial Hospital, Atlanta, Georgia. Results: Of the 100 patients reviewed, 86% complained of urge incontinence and 78% complained of urinary urgency; however, 76% also complained of stress incontinence. Statistical evaluation of symptoms by analysis of varia nce showed no significant correlations between the symptoms of urinary frequency and urgency and any of the cystometric indices. Patients wi th motor urge incontinence had significantly smaller mean cystometric bladder capacities than patients without this complaint (299.9 +/- 132 .5 versus 553.6 +/- 173.6 mL; P <.01). One-third (34) of the patients had mixed incontinence due to genuine stress incontinence as well as d etrusor instability. Compared with patients suffering from detrusor in stability alone, patients with mixed incontinence had significantly la rger cystometric bladder capacities (396.0 +/- 172.9 versus 308.1 +/- 154.8 mL; P <.02) and a lower amplitude of the maximum detrusor contra ction (38.8 +/- 21.7 versus 49.9 +/- 25.1 cm H2O; P <.04). Conclusions : Women with detrusor instability represent a diverse population with a wide variety of symptoms and urodynamic findings. Patients with mixe d incontinence may represent a subpopulation distinct from those with pure detrusor instability. Further research that attempts to describe other discrete subpopulations of patients with detrusor instability ma y improve our understanding of this troublesome clinical problem. (Obs tet Gynecol 1994;83:108-12)