Voiding Disorders Research Articles

Management of daytime urinary incontinence and lower urinary tract symptoms in children

Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagnoses include overactive bladder syndrome, dysfunctional voiding and vaginal reflux as well as less common conditions like giggle incontinence, voiding postponement, pollakiuria and diabetes insipidus. In this paper, we discuss an evidence-based approach to the management of conditions causing daytime urinary incontinence and lower urinary tract symptoms in children from a general paediatrician's perspective.

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Non-neurogenic neurogenic bladder (NNNB) lies at the most severe end of the spectrum of the non-neurogenic elimination disorders in children. 1 Leclair M.D. Heloury Y. Non-neurogenic elimination disorders in children. J Pediatr Urol. 2010; 6: 338-345 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar When Ochoa and Gorlin 2 Ochoa B. Gorlin R. Urofacial (Ochoa) syndrome. Am J Med Genet. 1987; 27: 661-667 Crossref PubMed Scopus (54) Google Scholar reported their results in 1987, 33% of the 66 patients had renal functional impairment, 26% had hypertension, and 24% had end-stage renal failure. Editorial CommentUrologyVol. 78Issue 4PreviewNon-neurogenic neurogenic bladder is a term used to describe a form of bladder-sphincteric dysfunction in children. It is typically characterized by a combination of urinary incontinence, impaired and inefficient emptying, and recurrent urinary tract infections. Bowel dysfunction, including constipation and encopresis, are also common. The clinical and urodynamic sequelae are often identical to those in children with neurogenic bladder, except that no neurologic pathologic features can be demonstrated on physical examination or radiographic imaging. Full-Text PDF

Editorial Comment

Non-neurogenic neurogenic bladder is a term used to describe a form of bladder-sphincteric dysfunction in children. It is typically characterized by a combination of urinary incontinence, impaired and inefficient emptying, and recurrent urinary tract infections. Bowel dysfunction, including constipation and encopresis, are also common. The clinical and urodynamic sequelae are often identical to those in children with neurogenic bladder, except that no neurologic pathologic features can be demonstrated on physical examination or radiographic imaging. The urodynamic evaluation will reveal detrusor-external sphincter dyssynergia, and the urinary tract decompensation can range from diurnal incontinence to elevated postvoid residual urine volumes to upper tract deterioration from vesicoureteral reflux, elevated filling pressures, and impaired bladder compliance. The treatment of this condition has been aimed at restoring low-pressure urinary storage and efficient, timely bladder emptying. Urofacial Syndrome: A Subset of Neurogenic Bladder Dysfunction Syndromes?UrologyVol. 78Issue 4PreviewThe urofacial syndrome (Ochoa syndrome) is considered to represent a subgroup of the non-neurogenic bladder dysfunction, characterized by non-neuropathic bladder-sphincter dysfunction, along with a characteristic inversion of the facial expression with laughing. Recent research suggests that it is probably a genetic inherited disease transmitted in an autosomal recessive fashion and might represent a distinct entity. We report a case of this syndrome in a 14-year-old boy who presented with left pyelonephritis, hydronephrosis, and bladder dilation. Full-Text PDF ReplyUrologyVol. 78Issue 4PreviewNon-neurogenic neurogenic bladder (NNNB) lies at the most severe end of the spectrum of the non-neurogenic elimination disorders in children.1 When Ochoa and Gorlin2 reported their results in 1987, 33% of the 66 patients had renal functional impairment, 26% had hypertension, and 24% had end-stage renal failure. Full-Text PDF

Association of Attention Deficit and Elimination Disorders at School Entry: A Population Based Study

Attention deficit/hyperactivity disorder is a common comorbid disorder in children with nocturnal enuresis, daytime urinary incontinence and fecal incontinence. We assessed the specific association of these conditions in a population based sample. We hypothesized that children with elimination disorders have a higher rate of attention deficit/hyperactivity disorder, and that children with daytime urinary incontinence are more strongly affected than those with nocturnal enuresis. All children in a defined geographic area (Saarpfalz Kreis) were examined at school entry. Mean age was 6.22 years in 734 boys and 6.18 years in 645 girls. A questionnaire regarding elimination problems and the attention problems scale of the Child Behavior Checklist were administered as an interview to parents. Participation rate was 99.1% (1,379 parents). Of the children 71 (5.1%) had attention deficit/hyperactivity disorder problems of clinical relevance (7.1% of boys and 2.9% of girls). A total of 185 children (13.4%) were wet (nocturnal enuresis in 9.1% and daytime urinary incontinence in 4.4%) and 19 (1.4%) had fecal incontinence. Attention deficit/hyperactivity disorder symptoms were more common in children with urinary incontinence than nonwetting children (16.8% vs 3.4%). When controlled for confounding variables, only children with daytime urinary incontinence (but not nocturnal enuresis) had a significantly higher risk of attention deficit/hyperactivity disorder symptoms (OR 4.4). Attention deficit/hyperactivity disorder symptoms were increased in children with urinary incontinence in this population based sample. Children with daytime urinary incontinence were at greater risk for attention deficit/hyperactivity disorder than those with nocturnal enuresis. Screening and referral for specialized treatment of both disorders are recommended.

Urinary dysfunction in early and untreated Parkinson's disease

BackgroundUrinary dysfunction is common in Parkinson's disease (PD); however, little is known about urinary dysfunction in early and untreated PD patients.MethodsFifty consecutive untreated PD patients (mean age, 66.7; mean disease...

Comorbid psychiatric disorders in Arab children with Autism spectrum disorders

The objective of our study is to estimate the prevalence of comorbid psychiatric disorders in a sample of children with autism spectrum disorders (ASD) recruited from three Arab countries. We also examine the relationship between comorbidity and children's cognitive functioning and gender. Children who received a diagnosis of ASD ( n = 60) from a child psychiatric outpatient clinic in Mansoura (Egypt), Al-Ahsa (Saudi Arabia) and Amman (Jordan) were included in this study. Comorbid diagnoses were established with a clinical interview and a semi-structured clinical interview for children and adolescents (SCICA). In addition, for all patients the cognitive evaluation was measured given the range in age and level of ability. Sixty-three percent of the children were diagnosed with at least one comorbid disorder. The most commonly reported comorbid disorders were anxiety disorders (58.3%), ADHD (31.6%), conduct disorders (23.3%), and major depressive disorder (13.3%). Out of the total sample, Obsessive compulsive disorder was the most prevalent anxiety disorder (55%). Elimination disorders were also diagnosed in 40% of patients. These findings emphasize a wide variety of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.

Fragile X Syndrome and Elimination Disorders in a 6-Year-Old Girl

A case of a 6-year-old girl with multiple elimination disorders (nocturnal enuresis, functional urinary incontinence and fecal incontinence) and a fragile X-syndrome is described. The late diagnosis of the fragile X-syndrome had implications for treatment as well as for family interaction. With the knowledge of the diagnosis the parents reacted in a more understanding manner regarding the behavioral problems of the child, whereby the elimination problems were reduced. The need for further research on elimination disorders in children with genetic disorders is discussed.

1867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111867 LOWER URINARY TRACT SYMPTOMS AND PELVIC PAIN IN YOUNG WOMEN AND THE EFFECTS OF PEDIATRIC VOIDING DYSFUNCTION W. Stuart Reynolds, Roger Dmochowski, and Harriette Scarpero W. Stuart ReynoldsW. Stuart Reynolds Nashville, TN More articles by this author , Roger DmochowskiRoger Dmochowski Nashville, TN More articles by this author , and Harriette ScarperoHarriette Scarpero Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little is known about pelvic floor symptoms in young nulliparous women, particularly related to etiology and associated conditions. We performed an email-based survey at our institution collecting information on lower urinary tract (LUTS) and pelvic symptoms specifically in young women ascertaining the prevalence of pelvic symptoms (specifically frequency-urgency, urinary incontinence and pelvic pain or painful urination) and associated conditions. We hypothesized that women with pelvic floor symptoms would have an increased rate of childhood voiding and elimination disorders. METHODS Women older than 18 were anonymously recruited to complete an online questionnaire circulated by email to faculty, staff and students at our university medical center. Information regarding demographic information, medical and gynecologic history, voiding and pelvic symptoms and quality of life was obtained. RESULTS 811 respondents, aged 18–40, were analyzed for this study. Overall, 474 (58%) have symptoms either “frequently” or “all the time” and were considered to have pelvic floor dysfunction (PFD): 59 (7%) experience frequency/urgency; 334 (41%) experience urinary incontinence; and 81 (10%) experience pelvic pain. Of those with incontinence, 23% reported pure stress incontinence, 11% pure urge incontinence, and 14% mixed incontinence. Overall, 299 (37%) women reported a history of pediatric voiding or elimination dysfunction, either bedwetting (8%), frequency/incontinence (3%), urinary tract infections (17%), or constipation/encopresis (9%). 208 (44%) of patients with PFD had a history of pediatric dysfunction while only 91 (27%) with no PFD had a similar history (p<0.001). Patients with PFD vs. without PFD more frequently reported childhood bedwetting (9% vs. 7%), frequency/incontinence (4% vs. 1%), UTI (20% vs.12%), and constipation (11% vs.7%) [p<0.001]. A history of any pediatric dysfunction was associated with an increased prevalence of PFD (adjusted OR 1.94, 95% CI [1.42, 2.63]), when corrected for overall health, mode of delivery, exercise and endometriosis on multivariate regression analysis. CONCLUSIONS Pelvic symptoms (LUTS and pelvic pain) are common in women aged 18–40 years and appear to be associated with a history of childhood voiding and elimination disorders. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e749 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information W. Stuart Reynolds Nashville, TN More articles by this author Roger Dmochowski Nashville, TN More articles by this author Harriette Scarpero Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Elimination disorders: a critical comment on DSM-5 proposals

Elimination disorders are common in childhood and adolescence. Enuresis is defined as wetting from the age of 5 years and encopresis as soiling from 4 years onwards--after excluding organic causes. In the past few decades, many subtypes of elimination disorders have been identified with different symptoms, aetiologies and specific treatment options. The DSM-IV criteria no longer reflect this wealth of research data and a revision is needed. Classification systems of the International Children's Incontinence Society (ICCS) for enuresis and urinary incontinence and the ROME-III criteria for functional gastrointestinal disorders offer new and relevant suggestions for both clinical and research purposes. These are presented and discussed. Integration of these into DSM-5 is highly recommended.

Nonneurogenic Voiding Disorders in Children and Adolescents: Clinical and Videourodynamic Findings in 4 Specific Conditions

We determined if there were any unique findings regarding specific clinical manifestations and videourodynamics among our patients with nonneurogenic voiding disorders. A cohort of 237 normal children with lower urinary tract symptoms were evaluated by videourodynamics and uroflow/electromyogram, and divided into 4 groups based on the specific urodynamic findings 1) dysfunctional voiding (active electromyogram during voiding with or without detrusor overactivity), 2) idiopathic detrusor overactivity disorder (detrusor overactivity on urodynamics but quiet electromyogram during voiding), 3) detrusor underutilization disorder (willful infrequent but otherwise normal voiding) and 4) primary bladder neck dysfunction. Association of lower urinary tract symptoms, urinary tract infection, vesicoureteral reflux and abnormal urodynamic parameters within each condition was compared. The only strong correlation between a particular symptom and a specific condition was between hesitancy and primary bladder neck dysfunction. Urgency was reported to some degree with all 4 conditions. The most common abnormal urodynamic finding was detrusor overactivity, which was seen in 91% of patients with dysfunctional voiding. The highest detrusor pressures were seen in dysfunctional voiding during voiding and in idiopathic detrusor overactivity disorder during detrusor overactivity. Vesicoureteral reflux was seen in a third of children with dysfunctional voiding or idiopathic detrusor overactivity disorder, in all 8 boys with a history of urinary tract infection and in 51% of patients with febrile or recurrent urinary tract infections with lower urinary tract symptoms when not infected. Bilateral vesicoureteral reflux and bowel dysfunction were most common in dysfunctional voiding. On objective urodynamic assessment pediatric nonneurogenic voiding dysfunction can essentially be divided into 4 specific conditions. These conditions have distinct urodynamic features that distinguish them from each other, as opposed to their clinical features (particularly lower urinary tract symptoms), which frequently overlap and are not as defining as they are often presumed to be.

Non Invasive Urodynamic Assessment in Children—Are They Reliable? Validation of Non-Invasive Urodynamics in Children with Functional Voiding Disorders

To validate the non-invasive tests that can predict the type of bladder dysfunction normally diagnosed by invasive urodynamics. Children below 12 yrs of age were evaluated prospectively. Non-invasive urodynamic evaluation included history, clinical examination, frequency volume charting, ultrasonographic scan, urine analysis and renal function tests. Micturating cystourethrogram was carried out in children with recurrent urinary tract infections. All children underwent invasive urodynamic studies and the significance of association of the parameters of noninvasive assessment with invasive urodynamics was determined. Chi square test using Epi 6 software was used for statistical analysis of data. 41 children underwent invasive urodynamic studies. The commonest disorder was detrusor instability in 28 (68.2%). Dysynergic voiding was noted in 8 (19.5%). The study was normal in 5 (12.1%). Nocturnal enuresis with day time symptoms, holding maneuvers, small frequent voiding pattern (p<0.05) and a small capacity bladder with insignificant residue (p=0.0003) predicts detrusor instability. Straining (p=0.0006), large capacity bladder with significant post void residue in the absence of vesicouretric reflux (p<0.05) predicts dysyneric voiding. On combining the various non-invasive tests and validating them against invasive urodynamics in diagnosing detrusor instability and dysnergic voiding, they have a sensitivity of 88.4% and 87.5%, specificity of 72.7% and 69.2%, positive predictive value of 0.88 and 0.63 and positive likelihood ratio of 3.1 & 2.2 respectively. Functional voiding disorders can be diagnosed with reasonable accuracy by minimally invasive methods.

Substantial Deficiencies

The article has some serious methodological flaws. Preoperative data about quality of life and sexuality are lacking in 72.9% of patients, and for the 2 year observation period after surgery, data are available for merely 18% of subjects. This seriously limits the evidence of the study, which can be classified neither as a prospective nor as a retrospective study. The questionnaires do not do justice to impaired sexual functioning in both sexes. The Female Sexual Function Index (FSI) and the international Index of Erectile Function (IIEF) would have provided more adequate tools. Impaired innervation in women can be diagnosed on the basis of vaginal sensitivity, temperature perception, vibratory sensation, ability to experience vaginal orgasm, and lubrication (1). Erectile dysfunction in men that has been persistently present for more than 2 years is a known problem and should be mentioned preoperatively. An early solution to the problem as well as advice are required. The authors’ assumption, that adjuvant radiotherapy does not affect ED, cannot be answered methodologically because observation periods of more than 2 years are required to assess the situation (2). However, the assessment of bladder voiding disorder that is commonly associated with FSD by means of postoperative measurements of residual urine and micturition protocol is clinically justified (3). We evaluated 58 men with rectal carcinoma while investigating a similar clinical question. The patients were treated according to their tumor stage with deep anterior rectal and mesorectal resection (AR) or abdominoperineal extirpation of the rectum(APR) by using the water jet short needle knife (flush knife) technique. The mean period of aftercare was 35 months. The effect on sexuality and bladder voiding function was evaluated by using validated questionnaires (International Prostate Symptom Score [IPSS], [IIEF-5]). Impaired bladder voiding function necessitating therapy was not observed when the flush knife technique was used, independently of the surgical approach. ED requiring treatment occurred in 9 of 58 patients (15%) postoperatively. Using the flush knife technique in the context of rectal surgery enables neuroprotection of structures relevant to patients’ sexuality, in addition to incurring a lower degree of blood loss.

Conventional monopolar resection or bipolar resection in saline for the management of large (>60 g) benign prostatic hyperplasia: An evaluation of morbidity

The objective of this study was to compare the efficacy and safety of bipolar transurethral resection in saline (TURIS) and conventional monopolar transurethral resection (TURP) in men with voiding difficulties due to high volume (>60g) benign prostatic hyperplasia. Between May 2005 and January 2009, 66 men with bladder outlet obstruction due to large benign hyperplasia (BPH) (>60 g) underwent transurethral resection, either by Olympus monopolar or Olympus bipolar TURIS technique. Perioperative and outcome data were recorded and compared. There was no significant difference in patient age, prostate size, PSA, uroflow rate, post voiding residual urine, operation time, catheterization time, and hospital stay. In the monopolar TURP group, an important drop in serum sodium was observed (3.12 mmol/L), statistically significantly different (p = 0.012) from the 1.30 mmol/L drop in the bipolar TURIS group. One case of clinical TUR syndrome was observed in the conventional monopolar TURP group. Early and late complications such as clot retention, urinary retention, bladder neck stenosis, and urethral stricture were identical in both groups. The bipolar TURIS device is a valid treatment option for patients with BPH-related voiding disorders due to high volume BPH. Obviating the risk of TUR syndrome, this minimally invasive procedure may be a good surgical option in the urologist's armamentarium.

Practical Solutions for Children With Elimination Disorders

Practical Solutions for Children With Elimination Disorders

How do different tests evaluate sensation in the lower urinary tract?

Different tests can be used to evaluate lower urinary tract (LUT) sensation. The purpose of this study is to compare sensory tests in patients with voiding disorders. Seventy patients with various functional disorders of the LUT were admitted for a cystometry and an electrical perception threshold test of the bladder (bEPT) and distal urethra (uEPT). A pudendal EPT (pEPT) and pudendal somatosensory evoked potentials (pSSEP) were also determined. Correlations were calculated for somatosensory (uEPT, pEPT and pSSEP latency) and viscerosensory tests (volumes at filling sensations and bEPT). Fifty of the 70 patients (71%) had normal bladder filling sensations, with abnormal bEPT in 21/50 (41%), including 11 (22%) with no sensation at maximal electrical stimulation. Twenty out of 70 (29%) had an abnormal pattern of filling sensation, with increased bEPT in 13/20 (65%) and no sensation at electrical stimulation in 8/13 (40%). No significant correlation exists between filling sensation and bladder electrical perception thresholds (r < 0.005, p > 0.243). pEPT correlated with uEPT and SSEP (r > 0.035, p < 0.041). In patients with functional voiding disorders, the EPT can be disturbed independently of the bladder filling sensation. No significant correlation exists between volumes of filling sensations and bEPT (r < 0.005, p > 0.243). Therefore, both tests provide complementary information. Somatosensory tests of the pudendal nerve are correlated, so performing SSEP, pEPT and uEPT provides poor additional information to one of these tests alone. Somatosensory pudendal tests cannot be used to quantify filling sensation.

Prévalence des troubles psychopathologiques dans une population tunisienne d’enfants en difficultés scolaires

Introduction Learning difficulties are frequently associated with various psychopathological conditions. The nature of this association is not clear, psychopathology being possibly considered as a cause or as a consequence of school failure. Methodology In this cross-sectional study, a population of 287 children belonging to 1st and 3rd grades of elementary school were identified as facing school difficulties through standardized records by teachers and school physicians. One hundred and eighty of them underwent a comprehensive assessment including neurological, psychiatric, and cognitive and language evaluations. Psychiatric evaluation consisted in a semi-structured interview referring to DSM IV and using the Mini-International-Neuropsychological-Interview (MINI-kid). Results In 31% of cases, there were no mental disorders. For the remaining students, most prevalent mental disorders were current or former language disorders (apart from mental retardation): 22%, anxiety disorders: 19%, elimination disorders: 16%, attention deficit/ hyperactivity disorder: 11%, adjustment disorders: 10%, parasomnias: 3%, depression: 1.8%, simple tics: 3%. Conclusion This high comorbidity deserves further investigation to clarify possible causality and needs to be taken into consideration through a systematic investigation of mental disorders with students in situation of school failure.

Non-neurogenic elimination disorders in children

Non-neurogenic elimination disorders cover a wide spectrum of lower urinary tract and bowel dysfunctions, observed in the absence of a neurological background or lower urinary tract malformation. We reviewed conditions responsible for incontinence during bladder filling with normal voiding patterns (such as overactive bladder, giggle incontinence, post-void dribbling), and dysfunctional voiding syndromes. Dysfunctional elimination syndrome usually includes detrusor-sphincter dyscoordination, small-capacity overactive bladder or decompensated large poorly contractile bladder, and large-volume post-micturition residuals, occasionally associated with bowel dysfunction. At the most severe end of the spectrum lies the non-neurogenic neurogenic bladder syndrome, characterized by the association of a severe impairment of the upper urinary tract with a dysfunctional elimination syndrome. It must be emphasized that if the term 'non-neurogenic' relates to the absence of a neurological lesion, it is however conceivable that these conditions actually do have an underlying neurological cause that remains to be identified.

Primary Intramedullary Spinal Cord Germinoma -Case Report-

A 21-year-old woman presented with an intramedullary spinal cord germinoma and a history of gait disturbance and elimination disorder. Magnetic resonance (MR) imaging demonstrated two isolated lesions, one located within the medulla between T9 and T11, and another at the cauda equina (L2 to L3 levels). After partial reduction of the intramedullary mass, histological findings revealed that the tumor was typical germinoma. Further MR imaging revealed no evidence of intracranial germinoma. Combined chemotherapy (carboplatin and etoposide) and whole spine radiation were performed. Follow-up MR imaging showed that the enhanced mass at the L2-L3 levels had disappeared. No recurrence of the tumor has been detected 3 years after the operation, and no dissemination into the cranial area was detected. Cisplatin and etoposide chemotherapy combined with radiotherapy is recommended for primary spinal germinoma, and is effective for inhibition of both tumor dissemination and recurrence.

Structural and functional characteristics of urinary tract in offspring of Balkan endemic nephropathy patients

Balkan endemic nephropathy (BEN) is a familial chronic progressive tubulointerstitial disease of unknown aetiology that occurs with high prevalence in endemic rural environments of Serbia, Bosnia and Herzegovina, Croatia, Bulgaria and Romania. It has been documented only in adults. The aim of this study was to examine clinical markers of BEN in children and adolescent offspring of BEN patients. Prospective clinical trial involved two groups of children and adolescents: I consisted of 30 offspring of BEN patients and II of 29 offspring of non-BEN dialysis patients, both of them living in the same South Morava region of Serbia. All of them were healthy at the time of the investigation, not receiving any drugs. The study included personal and family history, physical examination, comprehensive laboratory analyses and renal ultrasound. Blood pressure (BP) was determined by using casual BP and 24 h ABPM in subjects older than 5 years. Urinary proteins were investigated by analysing microalbumin, alfa 1 microglobulin, beta 2 microglobulin and SDS-PAGE electrophoresis. GFR was measured by estimated creatinine clearance and by serum Cystatin C concentrations. There were no statistically significant differences in age, gender, history of urinary tract infections or functional voiding disorders between these two groups. All of the studied subjects had normal BP and GFR. Renal ultrasound was abnormal only in BEN offspring (6.66%) as well as increased urine concentrations of microalbumin (3.3%), alpha 1 microglobulin (10%) and beta 2 microglobulin (13.3%) while low molecular protein (<66,000 D) was prevalent in BEN compared with non-BEN offspring (21.43% vs. 3.7%). Renal abnormalities in offspring of BEN patients may be an early marker of BEN.This has to be confirmed in long term follow-up of a greater number of BEN paediatric offspring.

Primary Bladder Neck Dysfunction in Children and Adolescents III: Results of Long-Term α-Blocker Therapy

Primary bladder neck dysfunction is a nonneurogenic voiding disorder frequently overlooked in pediatrics. The diagnosis classically is made by videourodynamics but can also be made with noninvasive uroflow studies with pelvic floor electromyography. We report our long-term results using alpha-blocker therapy in patients with primary bladder neck dysfunction. We reviewed 51 neurologically normal children (mean age 11.6 years, range 3.5 to 17.8) meeting criteria for primary bladder neck dysfunction who underwent alpha-blocker therapy for at least 1 year. All patients were symptomatic with abnormal flow parameters and an electromyogram lag time of 6 seconds or more on initial uroflow/electromyography. Pretreatment and on-treatment uroflow/electromyogram studies were performed in all patients. Average and maximum uroflow rates, electromyogram lag times and post-void residual volumes were compared. After a mean followup of 46.2 months (range 12 to 124) mean average and maximum uroflow rates improved from 7.0 to 12.4 cc per second and from 12.4 to 20.3 cc per second, respectively, while mean electromyogram lag time decreased from 30.8 to 5.8 seconds (all p <0.01). Of the patients 85% reported subjective symptomatic relief. A total of 15 patients (29%) stopped alpha-blocker therapy for various reasons, none related to side effects. Repeat off-treatment uroflow/electromyogram studies showed that measured parameters reverted to pretreatment values (all p <0.05). Eight of these 15 patients eventually resumed alpha-blocker therapy, while only 3 remained asymptomatic off of the alpha-blocker. alpha-Blocker therapy continues to benefit children with primary bladder neck dysfunction even after 3 years of treatment. Few patients can come off of alpha-blocker therapy without returning to their pretreatment state, suggesting the condition is likely chronic in most patients.