Pediatric Voiding Dysfunction: Definitions and Management
Lusnia, C., DeMarco, R., & Sharadin, C. (2025). Pediatric Voiding Dysfunction: Definitions and Management. Medicina (Kaunas, Lithuania), 61(4), 594. https://doi.org/10.3390/medicina61040594
This journal article provides a comprehensive review of the various presentations and management strategies of voiding dysfunction in children and adolescents including urinary dribbling, incontinence, urgency, and frequency. As many as 55.6% of the pediatric population experiences bladder dysfunction, with the prevalence decreasing as children age. There are many associated conditions with pediatric voiding dysfunction, including psychiatric problems such as ADHD, developmental disorders such as ASD, and DM.
The work up for voiding dysfunction is vital in order to determine if the issue is anatomical, neurogenic, or functional. The workup should begin with a thorough history and physical exam followed by possible non-invasive testing, voiding diary, and questionnaires. The history should include symptoms, bowel function, prenatal history, birth history, developmental history, past medical history, family history, and diet. Additionally, the child should be specifically questioned for urinary symptoms and bowel symptoms. Questionnaires can be utilized to aid in history taking, including the “Dysfunctional Voiding Symptom Score.” Patients may be asked to keep a voiding diary, which allows for symptoms to be tracked over time. The diary includes voiding time, voiding volume, frequency of bladder movements, any incidences of urinary or bowel incontinence, and fluid intake for 2-7 days.
Physical examination should include a complete abdominal examination along with a genitourinary exam. A neurological exam should also be completed to assess for perineal numbness or lower back abnormalities. A rectal exam can also be performed. Lastly, during the entire examination look out for signs of physical or sexual abuse.
Providers should obtain a UA with culture to rule out UTI. Blood tests including BMP/CMP should also be done to assess kidney function. Additionally, patients can undergo a prevoid and post void ultrasound, renal and bladder ultrasound, and patch electromyography. After conservative treatment for three months, uroflowmetry or invasive tests can be pursued. A voiding cystourethrogram and urodynamics can visualize anatomic issues.
Treatment depends on the underlying cause and can include behavioral interventions, oral medications, Botulinum toxin Type A injections, neuromuscular or neuromodulation, and clean intermittent catheterization. Constipation management is also important. Treatment should be provided for children who are bothered by their symptoms or at risk for UTI and/or renal damage. First line intervention is behavioral interventions including urotherapy, hydration techniques, timed voiding, and pelvic floor training. After 6 months of behavior intervention, if a patient is still with symptoms the use of medication can be explored including oxybutynin or tamsulosin.
