Utility of Urodynamics in Children with Dysfunctional Voiding

Abstract

This review will allow the reader to understand the rationale for urodynamic testing in a child who is neurologically intact and is suspected of having dysfunctional voiding. We will look to define criteria that will prevent the overuse and unnecessary use of this invasive test in children. The literature does not support the routine use of invasive urodynamics for children with urge syndrome but does support its use for elucidation of dysfunctional voiding abnormalities in neurologically intact children. The child with functional voiding issues presents itself with factors that are different from the child with neurogenic causes of incontinence. The role of the brain cannot be taken out of the equation in the normal sensate child and its impact can be quite significant leading to results that may not be what is actually occurring in day to day life. It is also critical that the person ordering VUD understand that there is limited value in ordering these tests for urge incontinence and frequency since the diagnosis of DO can be made for the most part from the history. Judicious use of the VUD study can be quiet valuable in allowing the user to pinpoint in complex cases the cause of the incontinence or poor voiding dynamics that are present. VUD should be a final choice in the workup of the sensate child with functional voiding problems and rarely used as a first line evaluation.