Bladder instability: concept, clinical associations and treatment.

Bladder instability is a term that describes the occurrence of detrusor contractions whilst the patient is attempting to inhibit micturition. Bladder instability has enormous importance in the pathogenesis of many symptoms associated with lower urinary tract dysfunction. Although bladder instability may be suspected from the patients' history, absolute diagnosis depends on cystometry. The treatment of bladder instability is difficult and characterised by frequent patient relapses. Simple measures such as bladder training may be employed. Drug treatment is often effective but current therapies frequently result in unwanted side effects. Many surgical techniques have been developed to treat bladder instability. The unfortunate characteristic of most of these operations is that following an initial excellent response the patients' symptoms recur. It is essential that research should continue into the aetiology and treatment of this important condition.