Nephrourology: Focus On Child with Bladder Dysfunctions and Urodynamics

Abstract

Bladder dysfunction is a broad term used to describe different dysfunctional conditions of the bladder-sphincter complex, due to nonneurogenic and neurogenic causes. The International Children’s Continence Society (ICCS) provided guidelines on bladder dysfunctions which are better defined with the term lower urinary tract dysfunctions (LUTD) [3–6, 16, 17]. The ICCS classified two main groups of nonneurogenic conditions: nighttime (enuresis) and daytime (overactive bladder – OAB, dysfunctional voiding – DV, underactive bladder – UB, bladder and bowel dysfunction – BBD) conditions. They are more common problems in children and adolescents, leading to urinary incontinence (UI); LUTD seriously affect quality of life. Neurogenic bladder (NB) is the term applied to LUTD due to congenital or acquired neurological lesions. Depending on the site of neurological insult, urodynamic studies show pattern of detrusor overactivity or underactivity with or without sphincter dyssynergia. Due to pathophysiological reasons, urinary tract infection (UTI) and vesicoureteral reflux (VUR) are strong comorbid conditions in both nonneurogenic and neurogenic LUTD. This chapter focuses on definition, pathophysiology, and assessment of both nonneurogenic and neurogenic LUTD.