Nonneurogenic voiding disorders: what's new?
OBJECTIVE
Increased interest in pediatric nonneurogenic voiding disorders (NNVDs), urodynamic testing and therapeutic options make this a timely topic for review.


RESULTS
The major themes covered this year included diagnosis of NNVD by symptomatology and relationship to subsequent urodynamic findings and treatment outcomes; effect of bladder volumes and overdistention, test position, catheter size, catheter in or out during voiding and sex on flow rate, flow pattern, voiding pressures, presence of overactivity and interpretation of findings on both urodynamic studies and uroflow testing; associations between bowel disorders (constipation and encopresis) and NNVD, associations between behavioral disorders and bowel disorders as reflected by treatment response and effect on behavior; efficacy studies on symptom-directed therapies in NNVD, comparison of different biofeedback programs for treating dysfunctional voiding, Botox injections for overactive bladder and an adult anticholinergic for overactive bladder that underwent testing in children; enuresis topics included anticholinergics for treating monosyptomatic enuresis refractory to desmopressin, prevalence of enuresis when screening large numbers of healthy school-age children and its association with certain family characteristics and other bowel and bladder complaints and an update on the association of fluctuation of vasopressin and nightly urine output and its role in patient selection for desmopressin therapy.


CONCLUSIONS
While some studies simply validated the past work of others, there were several that dispelled beliefs by demonstrating the inaccuracy of predicting voiding disorders on the basis of uroflow alone or the minimal effect of catheter and test position on urodynamic results; behavior disorders require special care but are not an impediment to successful treatment. Newer therapies, including Botox injections and new or broadened indications for existing anticholinergics, in treating the overactive bladder in children need closer scrutiny.
Glassberg
Kenneth I
KI
Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, New York NY 10032, USA. Kglassberg@aol.com
Combs
Andrew J
AJ
D000293:Adolescent; D001676:Biofeedback, Psychology / Q000502:physiology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use; D014555:Urination Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014563:Urodynamics / Q000502:physiology; D014572:Urology / Q000639:trends*
D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A