Dysfunctional Voiding: Is it a Spectrum of Abnormalities with Corresponding Urodynamic Findings or One Distinct Disease?

Purpose: Children with no obvious anatomic or neurological abnormalities who present with various urinary symptoms such as urgency, frequency, incontinence or urinary tract infection (UTI) are often diagnosed as having dysfunctional voiding. However, it is likely that dysfunction voiding represents a spectrum of abnormalities with different etiologies. The purpose of this study is to correlate the clinical presentation of children diagnosed with dysfunctional voiding with specific urodynamic findings, with the goal of defining the different etiologies of dysfunction voiding. Materials and Methods: Clinical assessment and urodynamic evaluation was underwent for 84 children (mean age of 8.2 years, range 3-17) with urinary symptoms suggestive of dysfunctional voiding. All the patients had a normal urogram, voiding cystogram and neurological evaluation. Urodynamic study including urethral pressure profile (UPP) was performed using a 7 Fr, 4-channel membrane catheter in all patients. Urodynamic findings were then correlated with clinical presentation. Statistical analysis was performed using 95% confidence interval. Results: Enuresis with daytime symptoms was the most common mode of presentation and was associated more commonly with urodynamic findings of detrussor sphincter dyssynergia, overactive bladder and hypertonic bladder. Interestingly, children with dysfunctional voiding who presented with UTI had similar urodynamic findings. There was no correlation between UUP findings and clinical presentation or urodynamic findings. Similarly, there was no correlation between urodynamic findings and bowel function. Conclusions: Patients with dysfunctional voiding may have different clinical presentation but seem to demonstrate similar urodynamic findings. This suggests that dysfunctional voiding may be a discrete problem rather than a spectrum of diseases.