Urge incontinence with uninhibited detrusdor contraction had been known to be a typical findings observed in the supraspinal neurologic disorders such as cerdebrovascular accident(CVA). However, voiding difficulty with significant amounts of
residual
urine are frequently noted in the patients with organic brain diseases. Also, little is known the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik et al1 have identified a specific physiological
abnormality-detrusor
hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the
symptoms
and
urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outle obstruction or, pathologies in the brain. Of the 50 patients with
parenchymal
brain disease, 41 had CVA, 6 had parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH(detrusor hypereflexia) in 24,
DH
with
obstructive pattern in 8, IDD (imopaired detrusor contractility) in 5, normal findings in 5 patients Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were
noted
in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in and, senile dementia in 1 cases. Of the 5 patiens with IDC, CVDA was present in 2 and,
normla
aged
peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC cmomplained obstructive symntoms more frequently than irritative symptoms. On the contrary, DH patiens complained irritative symptoms more frquently than obstructive symptoms.
Mean
fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41
patients(53%).
The
fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile funmction of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without
anypathologies exhibited abnoral findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contratility. Urge incontinence due to DH has been known to be the most common findings in supraspinal
lesion.
However, these results showed that the impairment of detrusor contractility was also commonly fund in the patients with supraspinal lesions and, aged epoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and
it
may
need emptying of residual urine in addition to the administration of anticholinergics ro smooth muscle relaxants.
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