Pediatric voiding dysfunction is a condition where a child cannot fully empty their bladder.听
Pediatric voiding disorders can be classified in three types:听
- Failure to store听
- Failure to empty听
- Combination of failure to store and empty听
Pediatric Voiding Dysfunction Symptoms听
Pediatric voiding dysfunction can cause a range of symptoms including:听
- Persistent nighttime wetting听
- Daytime wetting听
- 滨苍肠辞苍迟颈苍别苍肠别听
- Urinary frequency听
- Urinary urgency听
- Recurrent urinary tract infections (UTIs)听
- Infrequent voiding听
- Straining to urinate or the need to 鈥減ush鈥 to urinate听
- 颁辞苍蝉迟颈辫补迟颈辞苍听
- Hematuria, or blood in the urine听
- Weak or interrupted stream听
Causes & Risk Factors for Pediatric Voiding Dysfunction听
There are many causes for why children may experience voiding dysfunction. These include:听
- Urinary tract infections (UTIs)听
- 颁辞苍蝉迟颈辫补迟颈辞苍听
- Emotional or physical stress (at home, school, etc.)听
- Behavioral influences (i.e., holding in urine, rushing in the bathroom, etc.)听
Some specific conditions that may cause pediatric voiding dysfunction include:听
- Congenital or acquired spinal cord abnormalities听
- Neurologic disorders听
- Mechanical blockages like urethral valves听
- Bladder instability听
- Abnormal pelvic floor activity for unknown reasons听
The most severe risk is degradation of kidney function from abnormally high bladder pressure and/or recurrent urinary tract infections.听Degradation of quality of life is an extremely critical component in treating voiding dysfunction in children.听
Prevention Strategies for Pediatric Voiding Dysfunction听
While pediatric voiding dysfunction is not always preventable if caused by other conditions, some ways to decrease the risk include:听
- Establishing bathroom schedules听
- Ensuring the bladder is completely empty听
- Avoiding bladder irritants especially before bedtime听
Evaluation and Treatment for Pediatric Voiding Dysfunction听
A number of tests are performed to do a comprehensive urodynamics assessment, which determines the status of the kidneys, bladder and urethra. These tests provide valuable information about bladder capacity, voiding and bladder pressure.听
- Uroflow with and without electromyography (EMG): A non-invasive study evaluating the volume and rate of urine flow per second. After completion, an ultrasound of the bladder is performed to determine if the child is fully emptying their bladder. This test evaluates:听
- Stability of the bladder听
- Peak urinary flow听
- Bladder capacity听
- Ability to empty the bladder听
- Simple Urodynamics: A study evaluating what the uroflow evaluates as well as:听
- How much pressure builds in the bladder as it fills听
- Whether the bladder is having involuntary contractions or is contracting normally听
- How full the bladder is when there is an urge to void听
- Videourodynamics: A study that integrates imaging technology with simple urodynamics to determine if there are any anatomic abnormalities in the bladder and urethra. This study adds contrast fluid to the fluid filling the bladder to image the shape of the bladder and urethra while the bladder is filling, having contractions and voiding. This study can also help determine if there are any other anatomic considerations like vesicoureteral reflux (VUR) or diverticula.听
If the evaluation indicates a pediatric voiding dysfunction, patients may be first managed with non-surgical treatment options. If those treatments are ineffective, surgical intervention may be required.听
Non-surgical treatment options include:听
- Biofeedback: A non-invasive technique to that teaches children how to control, relax and contract the pelvic floor muscles听
- Behavior modifications: Techniques such as bladder retraining, pelvic floor therapy, or dietary restrictions听听
听Surgical treatment options include:听
- Ureteral reimplant surgery听
- Bladder augmentation surgery听
- A combination of the above procedures听
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