Sphincter dyscoordination

The clinical presentation is completely different in older children. The main complaint is usually dys-uria or infection (Fig. 6.6). Megacystis and thickening of the bladder wall are less frequent. Kidneys are usually normal, as is renal function. The differential diagnosis should include the other causes of bladder outlet obstruction (see below) and functional disorders such as dysfunctional voiding with severe bladder-sphincter dyscoordination. Both VCU and urodynamic studies can be diagnostic (Fig. 6.7). In case of valves, there is reduced urinary flow with no reinforcement of the perineal electric activity. 

Fig. 6.7. a VCU in a 7-year-old boy with dysuria, showing extrinsic compression of the urethra due to abnormal sphincter contraction during micturition. This functional anomaly should not be mistaken for posterior urethral valves. Urody-namic studies favor dysfunctional voiding with bladder-sphincter dyscoordination during voiding. Biofeedback physiotherapy was carried out. Clinical outcome was favorable, b Follow-up VCU shows normalization of urethral anatomy during... 

Two types of urinary tract symptoms are commonly seen in MS incomplete bladder emptying and incontinence. Incomplete bladder emptying is due to dyscoordination of the external urethral sphincter and detrusor activity.14 Most patients who develop this condition require intermittent or permanent uri-I nary catheterization.14 Incontinence in most MS patients is... 

Fig. 14.2a-c. Male, 2 months old moderate bilateral fetal hydronephrosis, VCU. Reduced bladder filling volume (20 ml) residual urine early uninhibited detrusor contractions transformed into premature micturition, a Minor bladder trabecu-lation, short phase of normal micturition. b,c Dyscoordinated voiding, contraction of external urethral sphincter dilated posterior urethra, male spinning top urethra... 

Assessing dyscoordination between bladder and external sphincter during voiding without interrupted flow by VCU is a weak point of this technique. However, it is well known that electromyographic assessment of pelvic floor muscles assessment also is not reliable, with many artifacts noted (e.g., leg movements) (HObecke et al. 1999). 

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