title: Urethral meatus deformities in girls as a factor in dysfunctional voiding.
abstract: OBJECTIVE
  Girls with an anterior deflected urinary stream (ADUS) cannot void in the ideal toileting position, resulting in lower success rates of behavioral training programs. Purpose was to study prospectively the clinical effects of surgical meatus correction for ADUS in girls with dysfunctional voiding (DV).
  
  
  METHODS
  A cohort of 171 DV patients aged 6-12 years was investigated. All had recurrent urinary tract infections (UTIs), staccato or interrupted uroflow, and >10% residual urine on ultrasound. For study purposes, all underwent a urodynamic study (UDS) to confirm DV. ADUS was recognized at first examination in 55 patients (32%) and a dorsally directed meatal correction was performed to achieve a normal direction of the urinary stream. The non-ADUS group (116 girls) was given behavioral therapy (BT); however, a subgroup of 11 girls with ADUS was detected with persistent complaints after failed BT. These 11 girls also underwent a meatal correction.
  
  
  RESULTS
  All DV complaints were resolved in 25 of the 55 (45%) girls from the original ADUS group and 8 of the 11 (73%) girls from the second group. During UDS, in the ADUS group free of complaints after meatal correction, a significantly higher P(max) (102 cmH(2) O) was found compared to those who did not benefit from correction (P(max) 76 cmH(2)O).
  
  
  CONCLUSIONS
  In this study, 39% of female DV patients had ADUS complaints. After surgical correction, 50% were free of all complaints without requiring any further behavioral training. The fast recovery into a normal voiding pattern in these girls shows that a meatus deformity needs to be looked for in all girls presenting with DV.
authors.affiliation: Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, The Netherlands. a.j.klijn@umcutrecht.nl
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: Deirdre
authors.initials: D
authors.lastname: Bochove-Overgaauw
authors.forename: Pauline L
authors.initials: PL
authors.lastname: Winkler-Seinstra
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
mesh_terms: D001521:Behavior Therapy; D002648:Child; D005260:Female; D006801:Humans; D009426:Netherlands; D011187:Posture; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology; D014554:Urination; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures