Mahony D T, Laferte R O, Blais D J
Birth Defects Orig Artic Ser. 1977;13(5):455-70.
The physiologic importance of 12 integral storage and voiding reflexes has not been generally recognized and appreciated by clinicians. Pathologic overactivity of reflexes No. 9 and No. 10, the urethrodetrusor facilitatory reflexes, appears to be a very common factor in the etiology of the juvenile incontinence syndrome. Mild but urodynamically significant obstructive lesions of the distal urethra are a common predisposing factor to chronic urethritis and are potentially remediable by simple surgical procedures. Cystometric as well as symptomatic improvement is commonly observed postoperatively. The micturition reflex is extremely complex. Its excitability is dependent upon the balance of multiple vectors of both facilitatory and inhibitory influence from many sources, peripheral as well as central. The popular clinical concept of "uninhibited neurogenic bladder," based on the cystometrogram, is naive and simplistic. It deserves to be replaced by the term "unstable bladder" which acknowledges the neurologic and urologic complexities of micturition reflex instability and introduces no erroneous connotations as to the cause and potential treatability of an incontinence condition.
12种完整的储尿和排尿反射的生理重要性尚未得到临床医生的普遍认识和重视。第9和第10号反射（尿道逼尿肌促进反射）的病理性活动亢进似乎是青少年尿失禁综合征病因中一个非常常见的因素。后尿道轻度但在尿动力学上具有显著意义的梗阻性病变是慢性尿道炎的常见易感因素，并且有可能通过简单的外科手术得到治疗。术后通常可观察到膀胱测压以及症状方面的改善。排尿反射极其复杂。其兴奋性取决于来自许多外周和中枢来源的促进和抑制影响的多个向量之间的平衡。基于膀胱测压图的“无抑制性神经源性膀胱”这一流行的临床概念是幼稚和简单化的。它应该被“不稳定膀胱”这一术语所取代，该术语承认了排尿反射不稳定的神经学和泌尿学复杂性，并且对于失禁状况的病因和潜在可治疗性没有引入错误的含义。
