The overactive bladder in childhood: Long-term results with conservative management

Purpose: Idiopathic detrusor overactivity has not been thoroughly investiga ted and its natural history remains largely anecdotal. Bladder overactivity resulting from a neurogenic, anatomical or medical condition has been well described. Therefore, we assessed the long-term results of conservative tr eatment of children with idiopathic symptomatic refractory detrusor instabi lity. Materials and Methods: We reviewed the records of 58 patients who had an is olated finding of uninhibited contractions on urodynamics performed for ref ractory enuresis and daytime wetting between 1988 and 1994. Study exclusion criteria were chronic urinary tract infection, neurological lesion, anatom ical abnormality of the lower urinary tract and less than 12 months of foll owup. Results: Of the 30 children who met our study inclusion criteria 26 (87%) h ad complete (21) or significant (5) symptom resolution. Average time to res olution was 2.7 years (range 0.2 to 6.6). Patients with a 50% to 90% bladde r capacity expected for age were more likely to benefit from therapy than t hose with a bladder capacity outside of this range. Age and gender were not significant predictors of resolution although girls were more likely to ha ve resolution than boys. Conclusions: Idiopathic detrusor instability is amenable to conservative ma nagement in the majority of patients during a prolonged period. We advocate thorough urological and urodynamic evaluation to identify idiopathic detru sor instability as an etiology of enuresis and daytime wetting in complicat ed cases.