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[Bladder with non-coordinated voiding: urodynamics and clinical correlations]
R Martín-Crespo Izquierdo1, R Luque Mialdea
1Unidad de Urodinámica, Hospital Ntra. Sra. del Rosario, Madrid.
Insights
Pediatric non-coordinated voiding, characterized by sphincter constriction, can be treated with voiding reeducation and medication. Early diagnosis and treatment are crucial to prevent potential kidney damage.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
Background:
- Non-coordinated voiding is a condition affecting children, often presenting with urinary tract infections and voiding dysfunction.
- Urodynamic studies reveal sphincter constriction and increased post-voiding residual urine volume in affected children.
Purpose of the Study:
- To investigate the urodynamic pattern changes and clinical correlations following voiding reeducation and pharmacological treatment in pediatric patients.
- To assess the effectiveness of a combined treatment approach for non-coordinated voiding.
Main Methods:
- Prospective follow-up of 25 female children diagnosed with non-coordinated voiding.
- Treatment included voiding reeducation, anticholinergics, antibiotic prophylaxis, and muscle relaxants.
- Urodynamic studies were performed at baseline and during follow-up (mean 22 months).
Main Results:
- All patients showed sphincter constriction and increased post-voiding residual urine volume; 80% had bladder instability.
- Clinical remission preceded urodynamic remission in all cases.
- Two patients experienced clinical recurrence after treatment cessation before urodynamic normalization.
Conclusions:
- Non-coordinated voiding in children requires timely diagnosis and intervention.
- Combined therapeutic strategies can lead to clinical improvement, but long-term urodynamic normalization is essential.
- Early management is vital to prevent potential progression to renal failure.
Abstract:
25 children (female) with urodynamically proven non-coordinated voiding were followed prospectively. The objective was to study the changes of urodynamic pattern and its clinical correlation after voiding reeducation and pharmacological treatment. All patients presented with urinary tract infections and voiding disfunction symptoms. 5 children had vesicoureteral reflux on voiding cystography and 10 patients had established scars on DMSA scan at initial presentation. Urodynamic study showed constriction of the urinary sphincter during voiding and increase of post-voiding residual urine volume in all children, with bladder instability 20 (80%). Treatment consisted of voiding reeducation, anticholinergics, antibiotic prophylaxis and muscle relaxants. The mean of follow-up was 22 months. Clinical remission occurred prior to urodynamic remission in all girls. Clinical recurrence was observed in 2 girls after cessation of treatment prior to normalization of urodynamic pattern. Non-coordinated voiding should be diagnosed and treated at pediatric age to avoid its possible progression to renal failure in other period of life.