title: Dysfunctional Voiders-Medication Versus Urotherapy?
abstract: OBJECTIVE
  Dysfunctional voiding is defined as "habitual contraction of the urethral sphincter during voiding." Children with dysfunctional voiding remain a challenge, and the approach to and management of LUT dysfunction varies widely among programs and providers with the role of pharmacotherapy being ill defined.
  
  
  RESULTS
  Animated biofeedback is the current treatment modality of choice in children who are not responsive to standard urotherapy. Comprehensive biofeedback programs incorporate continued elimination education, voiding diaries, and home exercises with high success rates. Recent studies suggest botulinum toxin A results in persistent satisfactory results in select children with refractory dysfunctional voiding. Conservative measures including an aggressive bowel regimen and timed voiding are the mainstays of treatment, and motivated children with persistent symptoms often respond favorably to escalating urotherapy with biofeedback. Pharmacotherapy plays an ancillary role in the management of dysfunctional voiding.
authors.affiliation: Department of Urology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA, 52242-1089, USA. angela-arlen@uiowa.edu.|Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. angela-arlen@uiowa.edu.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Arlen
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D001676:Biofeedback, Psychology / Q000379:methods; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005081:Exercise Therapy; D006801:Humans; D001745:Urinary Bladder Diseases / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000317:Adrenergic alpha-Antagonists; D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A
keywords: Bladder-bowel dysfunction (BBD); Dysfunctional voiding; Lower urinary tract symptoms (LUTS); Pediatric; Urotherapy