Voiding Disorders in Children

What are voiding disorders and what are their symptoms?

Voiding disorders refer to conditions in which the lower urinary tract (the bladder, urethra, and surrounding muscles) fails to function properly. These disorders may involve issues with urine storage, voiding, or post-void residual problems.

What are the symptoms? Voiding disorder symptoms can be categorized into:

1. Storage Symptoms
   • Frequent urination (pollakiuria)
   • Nocturia (urinating at night)
   • Urgency (sudden need to void)
   • Urinary incontinence
2. Voiding Symptoms
   • Straining to void
   • Weak urine stream
   • Burning or pain during urination
   • Intermittent or dribbling voiding
3. Post-Void Symptoms
   • Sensation of incomplete bladder emptying
   • Post-void dribbling

In which age groups are voiding disorders most common?

Voiding disorders can occur at any age; however, they are more common in certain groups. The distribution is generally as follows:

Children:

• Enuresis (Bedwetting): Particularly common in children under 5 years old; bedwetting is the most frequent voiding disorder.
• Dysfunctional Voiding: Coordination issues between the bladder and urethra can occur in childhood.
• Congenital Anomalies: Anatomical abnormalities, such as posterior urethral valves, can lead to voiding disorders in children.

How is the diagnosis of voiding disorders made?

The diagnosis of voiding disorders is made through a detailed evaluation of the patient’s symptoms and the use of appropriate diagnostic methods. The process typically includes:

1. Patient History and Symptom Evaluation
   • Type and duration of symptoms: Frequency of voiding, nocturia, incontinence, and painful urination are carefully assessed.
   • Triggering factors: Factors such as infections, stress, medications, or surgical history are investigated.
   • Lifestyle: Information on fluid intake, diet, caffeine, and alcohol consumption is gathered.
2. Physical Examination
   • Abdominal examination: Evaluates bladder fullness.
   • Neurological examination: Checks reflexes and nerve functions.
3. Laboratory Tests
   • Urinalysis: Used to detect infections, bleeding, or other abnormalities.
   • Urine culture: Performed if a urinary tract infection is suspected.
   • Blood tests: Assess for diabetes and kidney function.
4. Imaging Methods
   • Ultrasound: Used to detect anatomical issues such as bladder fullness, stones, or tumors.
   • CT or MRI: May be used for a more detailed anatomical evaluation.
   • Urethrography: Helps evaluate urethral strictures or obstructions.
5. Urodynamic Tests
   • Measurement of bladder filling and voiding: Assesses the bladder’s storage and emptying capacity.
   • Uroflowmetry: Measures the urine flow rate.
   • Post-void residual (PVR): Measures the amount of urine remaining in the bladder after voiding.
6. Cystoscopy
   • Direct examination of the urethra and bladder: Used to detect anatomical abnormalities, stones, or tumors.
7. Specific Scales and Diaries
   • Voiding diaries: The patient records voiding frequency, urine volume, and episodes of incontinence.
   • Symptom assessment scales: May be used to quantify symptoms.

What diagnostic tests are used for voiding disorders?

The tests are performed to determine the cause of the symptoms and establish an appropriate treatment plan. Commonly used diagnostic tests include laboratory tests, imaging, urodynamic studies, and endoscopic examinations.