eMedicine Specialties > Pediatrics: Surgery > Urology

Voiding Dysfunction: Differential Diagnoses & Workup

Author: Christopher S Cooper, MD, FACS, FAAP, Associate Professor of Urology, Director of Pediatric Urology, University of Iowa, Children's Hospital of Iowa; Associate Dean for Student Affairs and Curriculum, University of Iowa Carver College of Medicine
Coauthor(s): Kenneth G Nepple, MD, Resident Physician, Department of Urology, University of Iowa Hospitals and Clinics; Stanley Hellerstein, MD, Pediatric Nephrologist, Children's Mercy Hospital of Kansas City; Ernest L Glasscock, MD Chair in Pediatric Research, Professor of Pediatrics, University of Missouri School of Medicine at Kansas City
Contributor Information and Disclosures

Updated: Jun 24, 2008

Differential Diagnoses

Enuresis
Urinary Tract Infection

Other Problems to Be Considered

Urethritis

Workup

Laboratory Studies

  • Urinalysis and quantitative urinary culture should be performed to evaluate for UTI. On urinalysis, the specific gravity (concentration) of the urine is noted as well as any evidence of underlying voiding problems based on the presence of hematuria, proteinuria, or glucosuria.

Imaging Studies

  • Imaging is typically not performed. Renal or bladder ultrasonography, VCUG, radiography of the lumbosacral spine, or MRI of the lumbosacral spine may be required in select cases.
  • If dribbling and ongoing wetting have been present lifelong, evaluation should be performed for an ectopic ureter in the form of an intravenous urography.

Procedures

  • Special equipment for uroflow, bladder ultrasound, and urodynamics are typically available only at urologic facilities.
  • Noninvasive uroflowmetry and postvoid residual urine quantification (bladder ultrasonography or scanning) are useful, noninvasive tools in evaluating children for lower urinary tract dysfunction.
  • Urodynamic testing is not usually required; however, in select cases, urodynamic studies should be performed to detect uninhibited detrusor contractions, dysfunction of the pelvic floor muscles, or a hypotonic bladder.

More on Voiding Dysfunction

Overview: Voiding Dysfunction
Differential Diagnoses & Workup: Voiding Dysfunction
Treatment & Medication: Voiding Dysfunction
Follow-up: Voiding Dysfunction
References
[ CLOSE WINDOW ]

References

  1. Hellerstein S, Zguta AA. Outcome of overactive bladder in children. Clin Pediatr (Phila). Jul-Aug 2003;42(6):553-6. [Medline].

  2. Hellstrom AL, Hanson E, Hansson S, Hjalmas K, Jodal U. Micturition habits and incontinence in 7-year-old Swedish school entrants. Eur J Pediatr. Mar 1990;149(6):434-7. [Medline].

  3. Neveus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children's Continence Society. J Urol. Jul 2006;176(1):314-24. [Medline].

  4. Chandra M, Saharia R, Shi Q, et al. Giggle incontinence in children: a manifestation of detrusor instability. J Urol. Nov 2002;168(5):2184-7; discussion 2187. [Medline].

  5. Ellsworth PI, Merguerian PA, Copening ME. Sexual abuse: another causative factor in dysfunctional voiding. J Urol. Mar 1995;153(3 Pt 1):773-6. [Medline].

  6. Allen HA, Austin JC, Boyt MA, et al. Initial trial of timed voiding is warranted for all children with daytime incontinence. Urology. May 2007;69(5):962-5. [Medline].

  7. Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. Aug 1997;100(2 Pt 1):228-32. [Medline].

  8. Erickson BA, Austin JC, Cooper CS, et al. Polyethylene glycol 3350 for constipation in children with dysfunctional elimination. J Urol. Oct 2003;170(4 Pt 2):1518-20. [Medline].

  9. Sher PK, Reinberg Y. Successful treatment of giggle incontinence with methylphenidate. J Urol. Aug 1996;156(2 Pt 2):656-8. [Medline].

  10. Sureshkumar P, Bower W, Craig JC, et al. Treatment of daytime urinary incontinence in children: a systematic review of randomized controlled trials. J Urol. Jul 2003;170(1):196-200; discussion 200. [Medline].

  11. Van Arendonk KJ, Austin JC, Boyt MA, et al. Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder. Urology. May 2006;67(5):1049-53; discussion 1053-4. [Medline].

  12. Van Arendonk KJ, Knudson MJ, Austin JC, et al. Improved efficacy of extended release oxybutynin in children with persistent daytime urinary incontinence converted from regular oxybutynin. Urology. Oct 2006;68(4):862-5. [Medline].

  13. Youdim K, Kogan BA. Preliminary study of the safety and efficacy of extended-release oxybutynin in children. Urology. Mar 2002;59(3):428-32. [Medline].

  14. Kramer SA, Rathbun SR, Elkins D, et al. Double-blind placebo controlled study of alpha-adrenergic receptor antagonists (doxazosin) for treatment of voiding dysfunction in the pediatric population. J Urol. Jun 2005;173(6):2121-4; discussion 2124. [Medline].

  15. Kuh D, Cardozo L, Hardy R. Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort. J Epidemiol Community Health. Aug 1999;53(8):453-8. [Medline].

  16. Allen TD. The non-neurogenic neurogenic bladder. J Urol. Feb 1977;117(2):232-8. [Medline].

  17. Bloom DA, Faerber G, Bomalaski MD. Urinary incontinence in girls. Evaluation, treatment, and its place in the standard model of voiding dysfunctions in children. Urol Clin North Am. Aug 1995;22(3):521-38. [Medline].

  18. Bower WF, Sit FK, Yeung CK. Nocturnal enuresis in adolescents and adults is associated with childhood elimination symptoms. J Urol. Oct 2006;176(4 Pt 2):1771-5. [Medline].

  19. Bower WF, Yip SK, Yeung CK. Dysfunctional elimination symptoms in childhood and adulthood. J Urol. Oct 2005;174(4 Pt 2):1623-7; discussion 1627-8. [Medline].

  20. Cain MP, Wu SD, Austin PF, et al. Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol. Oct 2003;170(4 Pt 2):1514-5; discussion 1516-7. [Medline].

  21. Chandra M. Monographs in Clinical Pediatrics. In: Voiding and its disorders in children. Series Volume 10. Amsterdam. Harwood Academic; 1998:217-229.

  22. Chen JJ, Mao W, Homayoon K, et al. A multivariate analysis of dysfunctional elimination syndrome, and its relationships with gender, urinary tract infection and vesicoureteral reflux in children. J Urol. May 2004;171(5):1907-10. [Medline].

  23. Cooper CS. Current management of dysfunctional voiding. Dial Pediatr Urol. 2002;25(8):1-8.

  24. De Paepe H, Renson C, Van Laecke E, et al. Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int. May 2000;85(7):889-93. [Medline].

  25. Dohil R, Roberts E, Jones KV, et al. Constipation and reversible urinary tract abnormalities. Arch Dis Child. Jan 1994;70(1):56-7. [Medline].

  26. Forsythe WI, Redmond A. Enuresis and spontaneous cure rate. Study of 1129 enuretis. Arch Dis Child. Apr 1974;49(4):259-63. [Medline].

  27. Glazier DB, Ankem MK, Ferlise V, et al. Utility of biofeedback for the daytime syndrome of urinary frequency and urgency of childhood. Urology. Apr 2001;57(4):791-3; discussion 793-4. [Medline].

  28. Greenfield SP. The overactive bladder in childhood. J Urol. Feb 2000;163(2):578-9. [Medline].

  29. Hellerstein S, Linebarger JS. Voiding dysfunction in pediatric patients. Clin Pediatr (Phila). Jan-Feb 2003;42(1):43-9. [Medline].

  30. Hellerstein S, Stern L, Alon U. Voiding dysfunction in pediatric patients: a clinical approach to diagnosis and management. Children's Hospital Quarterly. 1990;2(3):213-225.

  31. Hoebeke P, Van Laecke E, Van Camp C, et al. One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction. BJU Int. Apr 2001;87(6):575-80. [Medline].

  32. Hoebeke P, Vande Walle J, Everaert K, et al. Assessment of lower urinary tract dysfunction in children with non-neuropathic bladder sphincter dysfunction. Eur Urol. Jan 1999;35(1):57-69. [Medline].

  33. Homsy YL. Constipation and UTI. Dialog Pediatr Urol. 1998;21(12):5-7.

  34. Koff SA, Wagner TT, Jayanthi VR. The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol. Sep 1998;160(3 Pt 2):1019-22. [Medline].

  35. McKenna PH, Herndon CD. Voiding dysfunction associated with incontinence, vesicoureteral reflux and recurrent urinary tract infections. Curr Opin Urol. Nov 2000;10(6):599-606. [Medline].

  36. McKenna PH, Herndon CD, Connery S, et al. Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol. Sep 1999;162(3 Pt 2):1056-62; discussion 1062-3. [Medline].

  37. Mota DM, Victora CG, Hallal PC. [Investigation of voiding dysfunction in a population-based sample of children aged 3 to 9 years]. J Pediatr (Rio J). May-Jun 2005;81(3):225-32. [Medline].

  38. O'Regan S, Yazbeck S, Schick E. Constipation, bladder instability, urinary tract infection syndrome. Clin Nephrol. Mar 1985;23(3):152-4. [Medline].

  39. Ollendick TH, King NJ, Frary RB. Fears in children and adolescents: reliability and generalizability across gender, age and nationality. Behav Res Ther. 1989;27(1):19-26. [Medline].

  40. Pashankar DS, Bishop WP. Efficacy and optimal dose of daily polyethylene glycol 3350 for treatment of constipation and encopresis in children. J Pediatr. Sep 2001;139(3):428-32. [Medline].

  41. Robson WL. Diurnal enuresis. Pediatr Rev. Dec 1997;18(12):407-12; quiz 412. [Medline].

  42. Rogers MP, Gittes RF, Dawson DM, Reich P. Giggle incontinence. JAMA. Mar 12 1982;247(10):1446-8. [Medline].

  43. Rushton HG. Wetting and functional voiding disorders. Urol Clin North Am. Feb 1995;22(1):75-93. [Medline].

  44. Schulman SL, Quinn CK, Plachter N, et al. Comprehensive management of dysfunctional voiding. Pediatrics. Mar 1999;103(3):E31. [Medline].

  45. Varlam DE, Dippell J. Non-neurogenic bladder and chronic renal insufficiency in childhood. Pediatr Nephrol. Feb 1995;9(1):1-5. [Medline].

  46. Vincent SA. Postural control of urinary incontinence. The curtsy sign. Lancet. Sep 17 1966;2(7464):631-2. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

voiding dysfunction, overactive bladder, OAB, detrusor instability, functional voiding disorder, infantile bladder, nonneurogenic neurogenic bladder, non-neurogenic neurogenic bladder, occult neuropathic bladder, unstable urinary bladder, urge incontinence, urge syndrome, Hinman-Allen syndrome, underactive bladder, urinary tract infection, UTI, urethral irritation, urinary dribbling, dysfunctional voiding, urethritis, myelodysplasia, detrusor hyperreflexia, constipation, encopresis, giggle incontinence, detrusor sphincter dyssynergia, vesicoureteral reflux, VUR, hydronephrosis, meatal stenosis, sexual abuse

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Christopher S Cooper, MD, FACS, FAAP, Associate Professor of Urology, Director of Pediatric Urology, University of Iowa, Children's Hospital of Iowa; Associate Dean for Student Affairs and Curriculum, University of Iowa Carver College of Medicine
Christopher S Cooper, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, International Children's Continence Society, Phi Beta Kappa, Society for Basic Urologic Research, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth G Nepple, MD, Resident Physician, Department of Urology, University of Iowa Hospitals and Clinics
Kenneth G Nepple, MD is a member of the following medical societies: Alpha Omega Alpha and American Urological Association
Disclosure: Nothing to disclose.

Stanley Hellerstein, MD, Pediatric Nephrologist, Children's Mercy Hospital of Kansas City; Ernest L Glasscock, MD Chair in Pediatric Research, Professor of Pediatrics, University of Missouri School of Medicine at Kansas City
Stanley Hellerstein, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, and American Society of Pediatric Nephrology
Disclosure: Nothing to disclose.

Medical Editor

Bartley G Cilento, Jr, MD, Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School
Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.