Etiology and management of detrusor instability and XXXX .

@entity1 @entity322 @entity6684 @entity3971 @entity11440 @entity2645
The cause of detrusor instability and @entity322 remains elusive. Although @entity6684 is most prevalent at the extremes of age, GSI becomes more common with aging and @entity1 bearing, and therefore @entity322 is common, especially after menopause. Cystometry is used to diagnosis detrusor instability, but urethral closure pressure profilometry is required for assessment of @entity322 . @entity6684 is managed initially by behavioral therapy, and if this is not satisfactory then FES should be used depending upon availability. Drug therapy should start with @entity11440 at 2.5 to 5 mg twice-daily and increased as necessary to control symptoms. If the effects of therapy are minimal or side effects are too great, other medications or medication combinations should be tried. When the @entity1 does not respond to this level of therapy, transvesical @entity3971 injections should be considered, or, alternatively, a sacral selective neurolysis or neurectomy should be considered. Finally, invasive procedures will have to be considered starting with bladder transection, especially for the @entity1 showing response to medication but intolerant of side effects. Mixed @entity322 should be approached with conservative measures for each component. FES or @entity2645 therapy may help both conditions. If conservative therapy is not beneficial, surgical correction for GSI should be undertaken, with the knowledge that 35 to 50 per cent of @entity1 will also have cure of @entity6684 , while the remainder can be treated medically for the @entity6684 .
