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Comprehensive management of dysfunctional voiding
S L Schulman1, C K Quinn, N Plachter
1Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Insights
A multidisciplinary approach effectively treats pediatric dysfunctional voiding, reducing daytime-wetting and recurrent urinary tract infections (UTIs). This comprehensive care model shows significant improvement and cure rates in children, enhancing their quality of life.
Area of Science:
- Pediatric Nephrology
- Urology
- Child Psychology
Background:
- Dysfunctional voiding is a common pediatric issue causing daytime-wetting and recurrent urinary tract infections (UTIs).
- Effective management strategies are crucial to mitigate the medical and psychological impact on affected children.
Purpose of the Study:
- To evaluate the efficacy of a multidisciplinary treatment approach for pediatric dysfunctional voiding.
- To assess outcomes in a large cohort of American children treated at a specialized center.
Main Methods:
- A cohort of 366 children (mean age 8.5 years) with voiding dysfunction underwent urodynamic studies.
- Treatment included antibiotic prophylaxis, anticholinergic medication, biofeedback, and psychological counseling.
- Follow-up data for a minimum of 6 months was available for 280 children.
Main Results:
- Urge syndrome (52%) and bladder sphincter dysfunction (25%) were primary urodynamic findings.
- A significant number of children experienced improvement or cure: 69% for daytime-wetting, 64% reduction in recurrent UTIs, and 53% resolution of vesicoureteral reflux (VUR).
- Overall, 69% of children with daytime-wetting showed improvement or cure.
Conclusions:
- A comprehensive, multidisciplinary approach yields favorable outcomes for children with voiding dysfunction.
- This integrated care model effectively reduces the morbidity associated with pediatric voiding disorders.
- The study highlights the success of a specialized center in managing a large population of children with these conditions.
Objective:
Dysfunctional voiding is a major problem leading to daytime-wetting and recurrent urinary tract infection (UTI). Our center is devoted to treating children with dysfunctional voiding. We offer a multidisciplinary approach with a pediatric nephrologist, nurse practitioners, and a psychologist. This article is the first to describe the efficacy of this approach on a large population of American children.
Patients:
Between 1992 and 1995, 366 children with symptoms of voiding dysfunction were referred for urodynamic studies. Criteria were based on the child's age, symptoms, and failure to respond to empirical therapy. Females made up 77% of the population, and the mean age at referral was 8.5 years (range, 4 to 18 years). Day-wetting occurred in 312 (89%), night-wetting in 278 (79%), recurrent UTI in 218 (60%), and vesicoureteral reflux (VUR) in 48 (20%) of those undergoing voiding cystourethrography.
Results:
A minimum of 6 months' follow-up data (mean, 22 months) is available on 280 children (77% studied). Urge syndrome was the predominant urodynamic finding in 52%, followed by bladder sphincter dysfunction in 25%. Treatment consisted of antibiotic prophylaxis (59%), anticholinergic medication (49%), biofeedback (25%), and psychological counseling (15%). Of the 222 children with daytime-wetting (45%), 100 are cured (off all medication, no wetting) and 82 (37%) are improved (on medication or >50% reduction in symptoms). Improvement or cure was seen in 69% of children with night-wetting. Of the 199 children with UTI, 127 (64%) never developed another infection. Vesicoureteral reflux resolved in 16 of 30 (53%) children undergoing repeat voiding cystourethrography.
Conclusion:
Our comprehensive approach demonstrates a favorable outcome that promises to reduce the medical and psychological morbidity seen in patients with voiding dysfunction.