Uncoordinated urinary syndrome. New aspects of an old problem

Abstract

Uncoordinated voiding, since it was described by F. Hinman in 1973, have remained an ambiguous concept. Its clinical aspects are well known, but an urodynamic definition and therapeutic guidelines are lack. Through this work, we are going to discuss clinical and urodynamic aspects of Uncoordinated Voiding Syndrome, and to evaluate sphincterian re-education techniques in this cases. We present a series of 50 consecutive patients with a diagnosis of Uncoordinated Voiding Syndrome. Mean age was 11.9 years old. There were 82% of female patients and only 18% male patients. A complete urodynamic study was accomplished in all patients, including video-cistometrography and superficial perineal electromiography to confirm the diagnosis. Therapeutic protocol consisted of three steps: 1 Manual pre-micturition training stage. 2. Electromiographic pre-micturition training stage. 3. Micturitional training stage. Most common clinic findings in our series were: enuresis (74%). urge-incontinence (70%), recurrent urinary tract infection (50%), intestinal disturbances (32%) and voiding difficult (20%). Based on our urodynamic findings, we have distinguished three sub-types of Uncoordinated Voiding Syndrome: I Type A, means micturition is achieved through a detrusor involuntary contraction. II. Type B, means micturition is achieved through a detrusor voluntary contraction. III. Type C, means micturition is achieved through abdominal straining. The most important urodynamic data in Uncoordinated Voiding Syndrome was independently of maximum flow, the absence of relaxation or increased perineal electromiographic activity during uroflowmetry. Pressure-flow test was fundamental to characterize Uncoordinated Voiding Syndrome. In our serie, 58% of patients were classified as type A, 28% as type B and 14% as type C. Sphincterian re-education obtained 64% of positive results, with 42% of patients being cured and 29% of them being improved. No result was obtained in 14% of patients. Two percent of patients relapsed after a remission period. Twenty percent of patients were excluded of the study because diverse reasons. Once treatment finished, clinical results remained stable during follow-up.