Natural history of voiding dysfunction

Voiding dysfunction leads to daytime wetting, night-time wetting, and recurrent urinary tract infection (UTI). Our interdisciplinary center has been committed to treating children with dysfunctional voiding since 1992. We describe the long-term follow-up of a large cohort of children using our approach to treatment. We reviewed the records of 199 children with symptoms of voiding dysfunction seen between March 1992 and December 1993. We contacted 98 parents and 51 patients by phone at least 6.5 years after initial presentation and asked about current symptoms, effective strategies, and satisfaction of care. Of the initial group of contacted parents, 81 (83%) were female with a median age of 7.8 years. Patients were followed in the clinic for a mean time of 1.6 years and a median of three visits. Of the 90 patients with daytime wetting, 82 (91%) reported complete resolution with a median time of resolution of 2.9 years. Parents felt that maturation was the most important factor leading to improvement. Of the patients that were directly contacted (41 females, 10 males, median age 15.2 years), all were dry and 86% denied any sense of urgency; 86% of parents and 87% of patients were highly satisfied with their care. Almost every child improved within 5 years of the initial evaluation. Only small fractions are still wet, are infected, or have urgency. Maturation seems to be the most important factor leading to improvement. Most parents and patients are satisfied with this form of treatment.