Overactive bladder in children. Part 1: Pathophysiology

Purpose: Detrusor overactivity is the most common voiding dysfunction in children. Detrusor overactivity is also known as overactive bladder syndrome, urge syndrome, hyperactive bladder syndrome, persistent infantile bladder and detrusor hypertonia. It has become apparent that the ideas that had been used to dictate the management of this problem in children were based on the foundation that this is a primary bladder problem and/or a delay in maturation in the nervous system of children. The expectation that children would outgrow the problems led many pediatric urologists and other practitioners to tell the parents of these children that they would not be wetting themselves on their wedding day. It has become apparent from recent studies in adults with voiding dysfunction that they had symptoms present as children. The recent findings of associations with lower urinary tract symptoms and sexual dysfunction, and the association of voiding dysfunction and neuropsychiatric problems has opened up a new frontier into the possible mechanisms of overactive bladder syndrome in children that would explain these problems, tie them together and explain the continued problems that adults face. These findings point to overactive bladder syndrome as a symptom of a more centrally located dysfunction that affects multiple systems, notably bowels, bladder, sexual and ejaculatory function, control of blood pressure, and even mood and behavior. Materials and Methods: We looked at the neuroanatomy, neurophysiology and neuropharmacology of voiding. Available research and clinical data in the urological field as well as outside of the field were combined to generate a unified theory that could possibly explain many associated symptoms that are commonly found in pediatric overactive bladder syndrome. Results: The available data indicate that pediatric overactive bladder syndrome and many pediatric voiding dysfunctions may be part of a more generalized problem that affects multiple systems, notably bowels, bladder, sexual and ejaculatory function, control of blood pressure, and even mood and behavior. We explained the relationship that the bowel has with pediatric overactive bladder syndrome and also the link that other neuropsychiatric problems have with overactive bladder syndrome. Conclusions: The movement away from a vesicocentric way of thinking to a more corticocentric mode of thinking along with new imaging modalities that can look at the brain and examine it as it works will be of great value for determining future treatments. Medications generated from these evidence based studies will hopefully treat the underlying disease process and not just the symptoms. © 2007 American Urological Association.