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.