Voiding Dysfunction Workup

Updated: Oct 22, 2021
  • Author: Christopher S Cooper, MD, FACS, FAAP; Chief Editor: Marc Cendron, MD  more...
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Approach Considerations

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

Evaluation of patients with suspected dysfunctional voiding should be performed by a urologist, and may include voiding cystourethrography (VCUG), urinary tract ultrasonography (US), urodynamic studies, and, in some instances, magnetic resonance imaging (MRI) of the lumbosacral spine to rule out a neurologic etiology.

If dribbling and ongoing wetting have been lifelong problems, the patient should be evaluated for an ectopic ureter.

Noninvasive uroflowmetry (commonly in conjunction with pelvic floor electromyography [EMG] [26, 27] ) and postvoid residual urine quantification (bladder US or scanning) are useful, noninvasive tools in evaluating children for lower urinary tract dysfunction.

Urodynamic testing is not usually required. In select cases, however, urodynamic studies should be performed to detect uninhibited detrusor contractions, dysfunction of the pelvic floor muscles, or a hypotonic bladder.

Any child with evidence of neurologic dysfunction (eg, cutaneous signs, physical examination findings, severely refractory voiding dysfunction, or urodynamic evidence of neurogenic bladder) should be further evaluated for occult neurologic lesions.

Special equipment for uroflow, bladder US, and urodynamics is typically available only at urologic facilities.