Voiding Dysfunction in Children: Role of Urodynamic Studies

INTRODUCTION: Urodynamic examination is said to be the most reliable, but also a rather invasive tool for the diagnosis of dysfunctional voiding in children. We compared the usefulness of baseline diagnostics to urodynamics. MATERIALS AND METHODS: 60 children, mean age 9 years, admitted for further evaluation of voiding dysfunctions (monosymptomatic nocturnal enuresis, 17; recurrent urinary tract infection, 12; reflux, 2; urgency, incontinence or residual urine, 29) underwent clinical examination, ultrasound, uroflowmetry, endoscopy and urodynamics. RESULTS: Urodynamic evaluation revealed pathologic findings in 37 patients. Detrusor instability was found in 26 children, 11 children (18%) demonstrated signs of pelvic floor overactivity. Treatment decision was based on baseline diagnostics exclusively in 14 children, mainly on baseline diagnostics in 56 patients, and on urodynamics exclusively in 4 children (7%). CONCLUSION: In children with idiopathic dysfunction, urodynamics did not have a significant additional value compared to baseline diagnostics. Therefore, noninvasive methods should be the first-line diagnostic tools. Only in patients with unsuccessful initial treatment should a urodynamic examination be performed to rule out severe bladder dysfunction.