Fractionated Bladder Voiding vs. Instable Bladder
Left picture: The diagnosis is a fractionated bladder voiding disorder. The insufficient evacuation of urine is not only disturbing for the girl, but leads essentially to repeated urinary tract infections. Right picture: Here, the diagnosis is an instable bladder which is very troublesome due to the episodically occurring urge symptomatology, and leads, in spite of the resulting retaining maneuvres, to enuresis (look at the oscillations of the electromyography in the undermost black curve).
Left picture: In this 5.3-year-old girl with bladder voiding disorders, in which the child starts micturation repeatedly, with the urine being voided in small portions, and recurrent urinary tract infections, 8 episodes of micturation are visible in the uroflow instead of a continuous curve during a voiding time of 232.3 seconds; the 8 episodes of micturation amount only to one third of the total voiding time, reach a maximum flow rate of only 4.6 ml/s, and are partially ineffective. Right picture: In this 7.5-year-old girl an urge symptomatology and an enuresis diurna is present. Instead of uroflowmetry a filling cystomanometry has been performed. Analogous to the picture of the contralateral patient the course of the curve is abnormal, in this case on filling the bladder: The increasing bladder or detrusor muscle pressure is superimposed by repeated oscillations, which correspond to spontaneous contractions of the detrusor muscle. For that, look at the waves with oscillations larger than 15 cm H20 in the uppermost blue curve.