Normalized Dysfunctional Voiding Through Timed Voiding | JoVE Visualize

Area of Science:

Pediatric Urology
Voiding Dysfunction
Pediatric Nephrology

Background:

Dysfunctional voiding, febrile urinary tract infections (UTIs), and bladder overdistention (BOD) are significant pediatric urological concerns.
Bladder overdistention can lead to secondary dysfunctional voiding and elevated postvoid residual (PVR) urine volumes.
Recurrent UTIs in children necessitate effective management strategies to prevent long-term complications.

Purpose of the Study:

To investigate the impact of bladder overdistention on dysfunctional voiding and recurrent UTIs in a pediatric patient.
To evaluate the efficacy of urotherapy, specifically timed voiding, in managing bladder overdistention and preventing UTIs.
To assess the potential for reversing bladder overdistention and its associated symptoms through behavioral interventions.

Main Methods:

A case study of a 3-year-old girl presenting with dysfunctional voiding, febrile UTIs, and BOD.
Initial management included UTI control followed by uroflowmetry and frequency/volume charting.
Intervention involved urotherapy with emphasis on adequate fluid intake and timed voiding to prevent BOD.

Main Results:

Initial uroflowmetry showed a staccato flow pattern and PVR >20 mL, with voided volumes exceeding 100% of expected bladder capacity.
Following urotherapy and timed voiding, uroflowmetry normalized, PVR decreased, and voided volumes remained within expected capacity.
The patient remained UTI-free for 12 months without prophylactic antibiotics, and again for 15 months after re-initiating timed voiding following a relapse.

Conclusions:

Bladder overdistention is a significant factor contributing to dysfunctional voiding, potentially leading to vesicoureteral reflux and recurrent UTIs.
Timed voiding is an effective urotherapy strategy for reversing bladder overdistention and preventing febrile UTIs in children.
Behavioral interventions like timed voiding can successfully manage dysfunctional voiding and prevent recurrent UTIs, obviating the need for prophylactic antibiotics.