Urodynamics in the Pediatric Patient: When to Order, How to Interpret

Abstract

The goal of this review is to elucidate the role of urodynamics in the assessment and management of lower urinary tract (LUT) dysfunction in children. Many children with LUT dysfunction will improve with an explanation of bladder and bowel function, advice on fluid intake and bathroom schedules, and treatment of constipation. Among those who fail to respond, urodynamics may be useful in guidance. There are four types of urodynamic studies: non-invasive urodynamics, uroflow, invasive urodynamics, and videourodynamics. This review outlines the information that can be obtained from these studies. Biofeedback is a non-invasive urodynamic technique which involves the visualization of LUT function to teach the child control over these muscles particularly the pelvic floor muscle. In the absence of success, other options are available for LUT management. Patterns of non-invasive urodynamics can be helpful in diagnosing and planning care for children with LUT dysfunction particularly if the pattern is consistent with history and home bladder diaries. Many diagnoses respond to pelvic floor exercises taught by biofeedback. Constipation plays a large role in LUT dysfunction and may respond to diet, medication, and biofeedback. More invasive testing and treatment is available for the few who do not respond.