Dysfunctional voiding

Many medications can influence the lower urinary tract, including those not used for managing genitourinary disorders, and can precipitate new onset or aggravate existing voiding dysfunction and urinary incontinence. 

Many medications can aggravate voiding dysfunction and UI (Table 84-1). 

McKenna, P.H., Herndon, C.D., Connery, S., and Ferrer, F.A. (1999) Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. / Urol 162 1056—1062 discussion 1062—1063. 

DHW stands for depth x height x width in centimeters) to obtain the bladder capacity from US in children with normally shaped bladders. Automatic devices are very useful and seem accurate to estimate bladder capacity and residual urine after micturition (Bladder Scan ), especially in patients with neurogenic bladders or any kind of voiding dysfunction. 

A good micturition study requires sequential filming (two spots/second) or a videotape recording (Potter et al. 1986) in order to detect voiding dysfunction (absence of coordination between blad-... 

Plister C, Dacher JN, Gaucher S et al (1999) The usefulness of minimal urodynamic evaluation and pelvic floor hio-feedback in children with chronic voiding dysfunction. Br J Urol 84 1054-1057... 

VCU is also useful because it provides a simultaneous evaluation of the bladder and urethra. The demonstration of voiding dysfunction, bladder wall thickening, or diverticula may help to characterize and understand VUR (Fotter et al. 1986 Koff 1992). Urethral obstruction, whatever its origin, may also be associated with secondary VUR (Fig. 11.7). 

Voiding dysfunction is another circumstance in which VUR is often detected (see Chap. 11). Voiding dysfunction is a frequent disorder mostly occurring in school-age girls. Most recent theories hypothesize that in such patients, VUR is not primary, but secondary to the bladder-sphincter dysfunction. Treatment of this type of VUR is unsuccessful unless the dysfunction is treated as well (Seruca 1989 Snodgrass 1998 Sillen 1999a Nielsen 1989). 

As mentioned above, VUR may be associated with voiding dysfunction furthermore, VUR is frequently associated with bladder outlet obstruction whatever its origin, or with neurogenic bladder disorders (Figs. 11.16, 11.17). Therefore, a VCU is the best-adapted examination for evaluating these patients furthermore, analysis of the micturition phase and evaluation of the urethra must be part of every VCU (Van Gool 1995). 

In older children, the attitude must be adapted to the previous history of the patient and to the clinical data. Medical treatment should be favored as much as possible. However, recurrent UTI would be an argument towards proposing an alternative treatment. Whenever a voiding dysfunction is also present, resolution of the VUR will be achieved only if the voiding anomaly is managed at the same time (SiLLEN 1999a). 

Seruca H (1989) VUR and voiding dysfunction a prospective study. J Urol 142 494-498... 

Nonneurogenk Bladder-Sphincter Dysfunction ("Voiding Dysfunction")... 

Nonneurogenic Bladder-Sphincter Dysfunction ( Voiding Dysfunction ) in Neonates and Infants 282... 

The prevalence of nonneurogenic bladder-sphincter dysfunction ( voiding dysfunction ) in children is high. One or more symptoms of disturbed bladder function were reported in up to 26% of children. Overactive bladder (unstable bladder) turned out to be the most common dysfunction. 

Of greatest importance is the observation by Naseer and Steinhardt (1997) who, in their study on 538 patients with a history of daytime urinary incontinence, identified 51 children with VUR, UTI and dysfunctional voiding in whom new renal scars had developed while they were under care. They concluded that voiding dysfunction is a significant risk factor not only for UTI and VUR development and perpetuation, but also for the development of new renal scars when associated with infection and VUR. An association between urinary tract dysfunction and reflux nephropathy was also demonstrated by Nielsen (1984). 

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