Lower Urinary Tract Dysfunction

Abstract

Functional urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are more common problems in children and adolescents, which may seriously affect quality of life. They are 1.5 times more common in girls than in boys at age 7 years, whereas at age 16 years the difference is more pronounced: five to ten times more common in girls than in boys. The prevalence of UI and LUTS is widely variable between 3.2 and 9 % in different studies (Abrams P, Cardozo L, Khoury S, Wein A (2013) Incontinence. ICUD-EAU eds). The main explanation of this wide variation is that different studies have used different definitions and criteria to define UI and LUTS. In 2006 the International Children’s Continence Society (ICCS) published a standardized terminology for lower urinary tract (LUT) function and dysfunctions (LUTD) to provide guidelines for the classifications and communication about UI and LUTS in children (Neveus et al. J Urol 176: 314–324, 2006). The ICCS has classified daytime LUTD in two main groups: overactive bladder (OAB), including urge incontinence, and dysfunctional voiding (DV), with or without underactive bladder. The two groups may overlap and clinical distinction between OAB and DV is based on characteristics of four symptoms: incontinence, voiding frequency, micturition volumes, and fluid intake. Knowledge of both LUTD is mandatory to distinguish children with OAB from those with DV and to offer correct treatment. Therefore, definition, pathophysiology, and clinical assessment of both OAB and DV will be provided in this chapter, focusing on treatment of DV.