title: A provocative maneuver to elicit cystometric instability: measuring instability at maximum infusion.
abstract: OBJECTIVE
  We identify a provocative maneuver to enhance the sensitivity of cystometry in detecting detrusor instability when urge incontinence is suspected based on clinical history.
  
  
  METHODS
  A total of 134 consecutive women with clinical urge incontinence underwent carbon dioxide cystometry between August 1995 and October 1996. The bladder was filled to maximal capacity with the patient supine. Six provocative maneuvers were performed consecutively to evoke detrusor instability, including lying supine, rising to a seated position, walking toward the bathroom, handwashing, coughing and sitting on the toilet with instructions not to void. Subjects were divided into 2 groups depending on the order of maneuvers. Sitting on the toilet was the last maneuver for group 1 (80 patients) and was in the middle of the sequence for group 2 (54).
  
  
  RESULTS
  Sitting on the toilet evoked detrusor instability in 37.5% of group 1 and 53.8% of group 2. This maneuver with instructions not to void was the most provocative stimulus in eliciting detrusor instability with a detection rate of 68.4% for all subjects.
  
  
  CONCLUSIONS
  Sitting on the toilet with the bladder at maximal capacity is the most provocative maneuver for detecting detrusor instability. The incidence of suspected detrusor instability is enhanced by using this test during routine cystometry.
authors: Division of Urology, Urodynamics and Incontinence Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA.
authors: J M
authors: JM
authors: Choe
authors: M L
authors: ML
authors: Gallo
authors: D R
authors: DR
authors: Staskin
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D001743:Urinary Bladder / Q000503:physiopathology; D014549:Urinary Incontinence / Q000175:diagnosis* / Q000503:physiopathology; D014563:Urodynamics