title: Analysis of uroflow patterns in children with dysfunctional voiding.
abstract: OBJECTIVE
  Although a staccato uroflow pattern is considered representative of dysfunctional voiding (DV), we recently found that only a third of children with staccato flow had an active pelvic floor electromyography (EMG) during voiding. Here, we analyzed the reverse, that is, how often a staccato flow pattern occurs in children with documented DV. In addition, we reviewed what other flow patterns are prevalent in this condition.
  
  
  METHODS
  We reviewed our LUT dysfunction registry for children with EMG-confirmed DV. Uroflow patterns were categorized as staccato, interrupted, mixed (i.e., staccato and interrupted patterns), or grossly normal.
  
  
  RESULTS
  Of 596 children who underwent a uroflow/EMG examination, 121 had an active pelvic floor EMG during voiding, that is a finding consistent with the diagnosis of DV. The flow patterns identified in those diagnosed with DV were staccato in 70 (58%), interrupted in 22 (19%), mixed in 12 (10%), and a bell-shaped or depressed curve in 17 (14%). Staccato pattern became normal in 96% following successful treatment with biofeedback.
  
  
  CONCLUSIONS
  While a staccato uroflow pattern was the most common pattern seen in children diagnosed with DV by a uroflow/EMG, nearly a third had an interrupted or mixed flow pattern underscoring the importance of performing simultaneous pelvic floor EMG during a uroflow study, especially when trying to rule out DV. Failure of the staccato flow pattern to normalize after therapy strongly suggests either inadequate therapy or an incorrect diagnosis.
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Department of Urology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
authors.forename: Sven
authors.initials: S
authors.lastname: Wenske
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Department of Urology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA. Electronic address: jpv2107@columbia.edu.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Van Batavia
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Department of Urology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Combs
authors.affiliation: Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York, Department of Urology, Columbia University, College of Physicians and Surgeons, 3959 Broadway, CHN 1118, New York, NY 10032, USA.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004576:Electromyography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis*; D008297:Male; D017773:Pelvic Floor / Q000503:physiopathology; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D053201:Urinary Bladder, Overactive / Q000503:physiopathology; D014554:Urination / Q000502:physiology; D014555:Urination Disorders / Q000175:diagnosis*; D014563:Urodynamics / Q000502:physiology*; D055815:Young Adult
keywords: Dysfunctional voiding; LUT dysfunction; Overactive bladder; Pelvic floor EMG; Uroflow pattern