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Published on: August 14, 2019
Dysfunctional Voiders-Medication Versus Urotherapy?
1Department of Urology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA, 52242-1089, USA. angela-arlen@uiowa.edu.
Insights
Dysfunctional voiding in children is challenging. Animated biofeedback and urotherapy are effective, with pharmacotherapy playing a minor role.
Area of Science:
- Pediatric Urology
- Urodynamics
- Child Health
Background:
- Dysfunctional voiding, characterized by urethral sphincter contraction during urination, presents management challenges in children.
- Current approaches to lower urinary tract (LUT) dysfunction vary, with an unclear role for pharmacotherapy.
Purpose of the Study:
- To review current treatment modalities for dysfunctional voiding in children.
- To clarify the role of pharmacotherapy in managing LUT dysfunction.
Main Methods:
- Review of current literature on dysfunctional voiding treatments.
- Analysis of the efficacy of urotherapy, biofeedback, and pharmacotherapy.
Main Results:
- Animated biofeedback is a primary treatment for children unresponsive to standard urotherapy.
- Comprehensive biofeedback programs, including education and home exercises, show high success rates.
- Botulinum toxin A offers satisfactory results in select refractory cases.
- Conservative measures like bowel regimens and timed voiding are foundational.
- Pharmacotherapy serves an ancillary role in managing dysfunctional voiding.
Conclusions:
- Animated biofeedback and comprehensive urotherapy are effective for pediatric dysfunctional voiding.
- Pharmacotherapy is not a primary treatment but can supplement other interventions.
- Refractory cases may benefit from botulinum toxin A or escalated urotherapy with biofeedback.
Purpose Of Review:
Dysfunctional voiding is defined as "habitual contraction of the urethral sphincter during voiding." Children with dysfunctional voiding remain a challenge, and the approach to and management of LUT dysfunction varies widely among programs and providers with the role of pharmacotherapy being ill defined.
Recent Findings:
Animated biofeedback is the current treatment modality of choice in children who are not responsive to standard urotherapy. Comprehensive biofeedback programs incorporate continued elimination education, voiding diaries, and home exercises with high success rates. Recent studies suggest botulinum toxin A results in persistent satisfactory results in select children with refractory dysfunctional voiding. Conservative measures including an aggressive bowel regimen and timed voiding are the mainstays of treatment, and motivated children with persistent symptoms often respond favorably to escalating urotherapy with biofeedback. Pharmacotherapy plays an ancillary role in the management of dysfunctional voiding.
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