title: The overactive bladder in childhood: long-term results with conservative management.
abstract: OBJECTIVE
  Idiopathic detrusor overactivity has not been thoroughly investigated and its natural history remains largely anecdotal. Bladder overactivity resulting from a neurogenic, anatomical or medical condition has been well described. Therefore, we assessed the long-term results of conservative treatment of children with idiopathic symptomatic refractory detrusor instability.
  
  
  METHODS
  We reviewed the records of 58 patients who had an isolated finding of uninhibited contractions on urodynamics performed for refractory enuresis and daytime wetting between 1988 and 1994. Study exclusion criteria were chronic urinary tract infection, neurological lesion, anatomical abnormality of the lower urinary tract and less than 12 months of followup.
  
  
  RESULTS
  Of the 30 children who met our study inclusion criteria 26 (87%) had complete (21) or significant (5) symptom resolution. Average time to resolution was 2.7 years (range 0.2 to 6.6). Patients with a 50% to 90% bladder capacity expected for age were more likely to benefit from therapy than those with a bladder capacity outside of this range. Age and gender were not significant predictors of resolution although girls were more likely to have resolution than boys.
  
  
  CONCLUSIONS
  Idiopathic detrusor instability is amenable to conservative management in the majority of patients during a prolonged period. We advocate thorough urological and urodynamic evaluation to identify idiopathic detrusor instability as an etiology of enuresis and daytime wetting in complicated cases.
authors.affiliation: Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Curran
authors.forename: M
authors.initials: M
authors.lastname: Kaefer
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: E
authors.initials: E
authors.lastname: Logigian
authors.forename: S B
authors.initials: SB
authors.lastname: Bauer
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004775:Enuresis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000188:drug therapy*