title: Functional daytime incontinence: clinical and urodynamic assessment.
abstract: Assessment of children with daytime wetting starts with the distinction between 'enuresis diurna' and 'functional incontinence', incontinence being defined as any form of wetting caused by bladder/sphincter dysfunction. Standard history-taking does not allow for a sharp enough distinction: pertinent questions have to be asked about daytime wetting, night-time wetting, micturition, and about urge and reactions to urge. By using urodynamics to expose the pathophysiology behind the patterns of bladder/sphincter dysfunction, these questions were formulated and validated in a series of 156 children, referred with persistent daytime wetting to a programme for cognitive bladder training. With history-taking organized into a simple questionnaire, complemented by urodynamics, four patterns of bladder/sphincter dysfunction emerged: urge syndrome, staccato voiding, fractionated and incomplete voiding, and lazy bladder syndrome. A strong correlation was found between recurrent urinary tract infections and non-neuropathic bladder/sphincter dysfunction, implying that detection and treatment of bladder/sphincter dysfunction is essential in every child with recurrent urinary tract infections, especially in the presence of vesico-ureteral reflux.
authors.affiliation: Division of Children's Surgical Associates Ltd., Philadelphia, PA.
authors.forename: J D
authors.initials: JD
authors.lastname: van Gool
authors.forename: M A
authors.initials: MA
authors.lastname: Vijverberg
authors.forename: T P
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000150:complications; D002675:Child, Preschool; D004775:Enuresis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008487:Medical History Taking; D011859:Radiography; D011795:Surveys and Questionnaires; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000150:complications; D014563:Urodynamics