Urodynamic assessment of voiding dysfunction and dysfunctional voiding in girls and women

Voiding dysfunction is defined as impaired bladder emptying, and presents w ith a mixture of lower urinary tract symptoms. Dysfunctional voiding is a c ondition in which there is a lack of coordination between the sphincter and detrusor during emptying in a patient without overt uropathy or neuropathy . Assessment of voiding dysfunction is important in women and girls in the prevention and treatment of urinary incontinence. retention, urinary tract infection and subsequent kidney damage. Accurate diagnosis is essential in order to select the correct treatment. Screening can be done by history-tak ing: symptom scores can help to guide the screening. More objective measure s are uroflowmetry, ultrasonography and video-urodynamics. The latter is th e gold standard for the diagnosis of voiding dysfunction and consists of si multaneous registration of pressure in the bladder and rectum and external sphincter behavior, either by electromyographic recording of pelvic floor a ctivity or by pressure recording at the external sphincter, during the whol e bladder cycle of filling and emptying. On fluoroscopy the bladder can be visualized throughout the filling and emptying phase. In dysfunctional void ing, hypertonicity and instability of the external urethral sphincter durin g filling cystometry and impaired external sphincter relaxation during empt ying are pathognomonic findings. Pressure-flow analysis reveals no obstruct ion and the detrusor contractility is low.