[Urodynamics of normal and disordered miction]

Abstract

The lower urinary tract undergoes a threefold nervous regulation. The normal miction is characterized by the fact that in the contraction of the detrusor an active reflected relaxation of the urethral occlusive mechanism develops. This could be proved experimentally at an animal model. On principle the miction could be disturbed on four ways: Incontinence, obstruction, neurogenic bladder, instability of the bladder. The most important differential diagnosis in the incontenencies is the differentiation between stress incontinence and urge incontinence, this differentiation is urodynamically significantly possible. In an obstructive disturbance of the miction one differs the mechanically fixed obstructions from the functional disturbances. For the two possibilities clinical instances are cited: Urethral valve--spastic neck of the bladder--detrusor-sphincter-dyssynergy. Neurogenic disturbances of micturition may be diagnosed only to the extent that their effect is objectiviable at the aim organ (urinary bladder and urethra). Non-neurogenic disturbances, however, show identical pictures, so that one may speak of a disturbance of micturition which corresponds to a certain type of neurogenic lesion. Every kind of disturbance of micturition needs an exact diagnostics. Urodynamic examinations are in every case necessary for the differential diagnosis of the individual disturbance.