Theories for occurrence:
(1) psychiatric problems (stress, depression, anxiety, etc.)
(2) learned behavior, with a lack of coordination between detrusor muscle contraction and relaxation of the external urethral sphincter.
Clinical features:
(1) The condition usually presents during childhood.
(2) Clinical symptoms may include enuresis, difficulty voiding, incontinence, fecal soiling and constipation.
(3) There is an increase in post-void residual urine volume.
(4) The bladder wall is thickened and trabeculated.
(5) The patient usually has recurrent urinary tract infections.
(6) The condition may be complicated by vesicoureteral reflux and hydronephrosis.
(7) The condition is potentially reversible if an underlying cause can be identified and corrected.
Findings that make the diagnosis unlikely:
(1) The presence of an anatomic lesion (stricture, etc) that can explain the findings.
(2) The presence of a neurologic lesion that can explain the findings.
