[The bladder immaturity syndrome. Apropos of 1097 cases].

Acquisition of control of micturition in children involves several stages, the most critical being the bladder immaturity phase. Although the passage from bladder automatism of the neonate to coordinated conscious bladder-sphincter activity in adults is usually a problem-free period, it is nevertheless a critical and sometimes dangerous phase in certain subjects. Purely functional disorders may induce, above a certain physiological limit, a true pathologic state considered up to the present as being organic in nature and requiring urodynamic exploration to confirm their individuality. This bladder immaturity syndrome has the common denominator of diurnal or nocturnal urine leaking, sometimes with an associated lower urinary tract infection in young girls. The first part of this review discusses a clinical trial conducted in 1 097 children (840 girls, 257 boys) age 4 to 15 years, with the "urine-leaking" symptom, divided into 2 groups as a function of its diurnal or nocturnal prevalence: Group I: diurnal incontinence alone: 285 children Group II: diurnal and nocturnal incontinence: 812 children Investigations included: a clinical examination including a full past history to determine possible infectious origin, the primary or secondary nature of the disorder, possible family history and particularly any associated diurnal micturitional disorders such as pollakiuria and urgency; cytobacteriology of urine; an I.V.U. reduced to a minimum of images; cystography and micturitional study; cystometry. Results in each group were expressed analytically, and showed assimilation of the 2 groups, having in common the incontinence-urine leaking symptom, whether it occurred during the day or night, with the diurnal manifestations of pollakiuria and urgency. This clinical feature derived from simple questioning was accompanied in 9 out of 10 cases by cystographic anomalies (notched bladder outline, modified proximal urethra in young girls, sometimes vesico-renal reflux) and cystometric changes (vesical hyperactivity and hypersensitivity). These findings provide better understanding of the significance of these clinical manifestations and their place within the framework of the urinary bladder immaturity syndrome. After a summary of the physiology of the bladder-sphincter apparatus and the stages of acquisition of micturitional control, with definition successively of the automatic, immature and adult bladder, the second part of the report discusses the urinary bladder immaturity syndrome itself. Symptoms are dependent on the urodynamic factors involved.(ABSTRACT TRUNCATED AT 400 WORDS)