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[Urodynamic studies in the child with urinary incontinence]
1Chirurgischen Klinik, Universitäts-Kinderspitals Zürich, Schweiz. schwoebm@kispi.unizh.ch
Insights
Distinguishing between enuresis and incontinence is crucial for diagnosing pediatric voiding disorders. Early diagnosis and targeted therapies, like uroflowmetry and pelvic floor physiotherapy, improve outcomes for children with these conditions.
Area of Science:
- Pediatric Urology
- Childhood Voiding Dysfunction
Context:
- Voiding disorders are common in children, necessitating accurate diagnosis.
- Differentiating between enuresis (inappropriate voiding) and incontinence (involuntary loss of urine) is key.
Purpose:
- To outline the diagnostic approach and therapeutic strategies for pediatric voiding disorders.
- To emphasize the importance of distinguishing functional from organic causes.
Summary:
- Enuresis has functional causes, while incontinence can be functional or organic (e.g., neurogenic bladder, structural anomalies).
- Functional incontinence subtypes include urge incontinence, dysfunctional voiding, lazy bladder syndrome, and stress incontinence.
- Uroflowmetry with pelvic floor electromyography (EMG) is the primary screening tool, followed by cystometry if needed.
Impact:
- Accurate diagnosis guides effective treatment, including bladder training, pelvic floor physiotherapy, and biofeedback.
- Therapeutic success relies on a collaborative approach between the child, parents, and healthcare providers.
- Understanding the underlying causes ensures appropriate management, improving quality of life for affected children.
Abstract:
Voiding disorders in children are frequent. To establish an exact anamnesis, it has to be distinguished between enuresis and incontinence and this may consequently already have a therapeutical effect. Enuresis is defined as a normal void occurring at an inappropriate time or place. Incontinence is an involuntary loss of urine and a pathological voiding habit, often in combination with urinary infections. The causes of an enuresis are always functional, the causes for incontinence may be organic or functional. Organic causes are neurogenic bladder dysfunctions or structural anomalies of the lower urinary tract. The functional causes are divided in urge incontinence, dysfunctional voiding, lazy bladder syndrome and stress incontinence. The most important screening examination in each child with voiding disorders is the uroflowmetry, in combination with an electromyography (EMG) of pelvic floor and abdominal muscles. For registration of the muscle activity, surface electrodes are used that only show muscle groups, but do not hurt on application. Cystometry, an invasive method, is used as a second step. The therapy of functional incontinence consists in bladder training, physiotherapy of the pelvic floor and biofeedback. Medicaments are given in second priority. The therapy of functional voiding disorders is only successful in cooperation with the child and its parents.