Title:Dysfunctional Voiding in Pediatrics: A Review of Pathophysiology and Current Treatment Modalities
Volume: 12
Issue: 4
Author(s): Maria Fernandez-Ibieta and Lidia Ayuso-Gonzalez
Affiliation:
Keywords:
Biofeedback, dysfunctional voiding, functional urology, incontinence, pediatric urology, urinary
leaks, urinary tract infections.
Abstract: In Dysfunctional Voiding (DV), the external urethral sphincter or pelvic diaphragm
(consisting of striated muscle) contracts during voiding, contrary to normal
physiological mechanism. In Flowmetry plus pelvic Electromyography (EMG), the perineal
surface electrodes will show a persistent activity during voiding. The cause is believed
to be the persistence of an immature bladder control. The overall prevalence of DV is estimated
between 7 and 11% of girls of school age. Symptoms of DV comprise a range of
symptoms, deriving from outlet obstruction, incomplete voiding and elevated Post Micturition
Residual (PMR): from daytime urine leaks, nocturnal enuresis, Urinary Tract Infections
(UTI), or Vesicoureteral reflux (VUR), to the final decompensation of upper urinary
tract in extreme cases. The literature reflects a high prevalence of constipation among these
patients: between 33 and 56% of dysfunctional voiders are constipated. Initially, therapy of
functional voiding disorders such as DV, comprises a series of fundamental principles
called Urotherapy or voiding re-education. Currently, Urinary animated Biofeedback (Bfb)
is the treatment modality of choice. This therapy discloses patients their own physiological
and muscular mechanisms. Majority of the studies on Bfb efficacy reflect an improvement/
cure rate of around 70-80%. Initial flowmetric improvement followed by symptom relief or
clinical improvement as the Bfb sessions continue, is likely to occur. It has been observed
that there are two variables associated with clinical success of Bfb in DV syndrome: the
absence of PMR at the end of treatment and an adequate or even aggressive constipation
management.
