Pediatric Voiding Dysfunction

Voiding disorders can be classified in three basic types: failure to store, failure to empty, or a combination of the two. These conditions can arise from a myriad of different causes ranging from congenital or acquired spinal cord abnormalities, to neurologic disorders, or to mechanical blockages like urethral valves.

We also see voiding disorders in children with bladder instability or abnormal pelvic floor activity for idiopathic, i.e. unknown, reasons. The most dire risk of voiding disorders is eventual degradation of kidney function from abnormally high bladder pressure and/or recurrent urinary tract infections. However, degradation of quality of life is also an extremely important component in the treatment of voiding disorders that should not be underestimated.

Pediatric Voiding Dysfunction - Evaluation

To achieve a comprehensive urodynamics assessment, we perform a number of tests simultaneously, which allows us to determine the status of the kidneys, bladder and urethra. Together these tests provide valuable information about bladder capacity, voiding and bladder pressure.

Uroflow with and without EMG

This study evaluates the volume and rate of urine flow per second in accordance with established norms. After completion, we perform an ultrasound of the bladder right in the unit to determine if the child is fully emptying their bladder. This is a completely non-invasive study.

This study is performed to allow us to evaluate:

• Stability of the bladder
• Peak urinary flow
• Bladder capacity
• Ability to empty the bladder

The EMG allows us to monitor pelvic floor muscle activity while voiding.

Simple Urodynamics

This study allows us to evaluate all of the above along with:

• How much pressure builds in the bladder as it fills
• Whether the bladder is having involuntary contractions or is contracting normally
• How full the bladder is when there is an urge to void

Videourodynamics

This study allows us to integrate imaging technology with simple urodnyamics to determine if there are any anatomic abnormalities in the bladder and urethra. This study is accomplished by adding contrast fluid to the fluid filling the bladder in order to image the shape of the bladder and urethra while the bladder is filling, having contractions and voiding. This study can also help us determine if there are any other anatomic considerations like vesicoureteral reflux (VUR) or diverticula.

Pediatric Voiding Dysfunction - Symptoms

Pediatric patients can present with any number of symptoms that can help differentiate a pathologic cause of a voiding disorder.

Symptoms may include:

• Persistent nighttime wetting
• Daytime wetting
• Incontinence
• Urinary frequency
• Urinary urgency
• Recurrent urinary tract infections
• Infrequent voiding
• Straining to urinate or the need to “push” to initiate urination
• Constipation
• Blood in the urine
• Weak or interrupted stream

Pediatric Voiding Dysfunction - Treatment Options

If urodynamic evaluation reveals a voiding disorder, we first try to manage patients conservatively. These options include biofeedback and behavior modifications.If conservative management is ineffective, we will attempt to manage the problem surgically. Surgical options include:

• Ureteral reimplant surgery
• Bladder augmentation surgery
• A combination of the above procedures

Would you like an appointment?

To request an appointment, please call our office at (212) 746-5337. Our phone staff are available to help you Monday-Friday, from 9AM-5PM (EST).

If you'd like to learn more about our providers that specialize in Voiding Dysfunction, please visit the "Our Care Team" page.