Detrusor overactivity

Detrusor pressure is only a partial reflection of bladder wall force. In order to better standardize the results of clinical studies, bladder wall activity has to be taken into account by relating detrusor pressures to volume levels. The 15 cm H 2 O threshold level is misleading. Tonic and phasic pressure changes have to be clearly distinguished. Standardization of technique can be improved by using diuresis cystometry. Urethral mobility and dysfunction have to be further investigated in relation to detrusor activity. Detrusor overactivity may be caused by factors which also cause stress incontinence and is therefore no contra‐indication for culposuspension. The occurrence of detrusor overactivity after culposuspension cannot be predicted. It can be treated pharmacologically and in case of resistance to therapy by an augmentation cystoplasty such as a CLAM operation. Investigation of the urethra is therefore more important than a cystometrogram prior to a culposuspension. A technique is described. Genuine stress incontinence is not a useful urodynamic diagnosis. In the aging male, detrusor overactivity is more frequent, with or without obstruction. In patients with benign prostatic hypertrophy and detrusor overactivity resistant to treatment, prostatectomy would be acceptable therapy.