Zinner N R
Doctors Urology Group, Torrance, CA 90505, USA.
Eur Urol. 1998;34 Suppl 1:16-9. doi: 10.1159/000052269.
According to the International Continence Society, detrusor instability (DI) is not a disease, it is a condition found only by urodynamic examination. Thus, the word instability is misleading. It implies that the bladder is abnormal. We do not think of unstable situations as being normal. It is inappropriate to use the term because it makes it too easy for clinicians to feel they have made a diagnosis when they have not. It curtails further thinking and does not promote the scientific pursuit of fact. What is the evidence that DI is abnormal? As described by the ICS in 1981, the patient must have no neurological bladder abnormality. Studies show it can be provoked in asymptomatic individuals and can be found 'naturally' with ambulatory urodynamic testing. A person may be clinically asymptomatic and totally unaware that the contraction is occurring. The findings are simply phasic pressure increases reflecting typical rhythmic contractions of visceral structures such as bowel and urinary bladder. This paper proposes the term 'phasic detrusor contractions' (PDCs). It has no connotation, describes the finding, and frees the clinician and scientist to explore the matter without prejudice.
根据国际尿控协会的定义，逼尿肌不稳定（DI）并非一种疾病，而是仅通过尿动力学检查才能发现的一种情况。因此，“不稳定”这个词具有误导性。它暗示膀胱是异常的。我们通常不认为不稳定的情况是正常的。使用这个术语是不合适的，因为这会让临床医生在尚未做出诊断时就轻易觉得自己已经做出了诊断。它限制了进一步的思考，不利于对事实进行科学探究。有什么证据表明DI是异常的呢？正如国际尿控协会在1981年所描述的，患者必须没有神经源性膀胱异常。研究表明，无症状个体也可能引发这种情况，并且在动态尿动力学检测中可以“自然地”发现。一个人在临床上可能没有症状，完全没有意识到这种收缩正在发生。这些发现仅仅是阶段性压力增加，反映了诸如肠道和膀胱等内脏结构典型的节律性收缩。本文提出“阶段性逼尿肌收缩”（PDCs）这一术语。它没有隐含意义，描述了这一发现，使临床医生和科学家能够毫无偏见地探索这个问题。
