Non‐invasive Assessments of Pediatric Voiding Dysfunction

Abstract

In the evaluation of pediatric dysfunction, the initial approach relies on non‐invasive diagnostic tools. Through these examinations, the possible etiology of pediatric voiding dysfunction may be identified, and children who require further evaluation with invasive diagnostic tools may be differentiated. In addition, these non‐invasive diagnostic tools can be used as surrogate parameters for follow‐up of voiding function in children with neurogenic or non‐neurogenic voiding dysfunction.Updated information and controversy on this issue are provided and discussed in the present review. Thorough and well‐organized history taking and focused physical examination are essential. A 2‐day bladder diary and a 14‐daysbowel movement diary, at least, should be recorded. Dysfunctional voiding symptom scores have been recommended for identifying children with possible voiding dysfunction. Consensus on which scoring system is best for clinical practice has not been reached. Low inter‐observer agreement in interpreting specific types of abnormal uroflow pattern and high inter‐observer agreement in identifying “no abnormality” make uroflowmetry a first‐line screening tool for pediatric voiding dysfunction. Optimal bladder capacity is paramount in the interpretation of uroflowmetry curves and postvoid residual urine (PVR). Voided volume <50 mL is not eligible, while bladder over‐distention may result in an abnormal uroflow pattern and increased PVR volume. Renal ultrasonography has been recommended for the evaluation of children with enuresis. However, the gain achieved through routine renosonography may be small. Thickened bladder wall thickness warrants further investigation of voiding dysfunction. However, inter‐ and intra‐examiner's variability does not yet make this examination popular.