One thousand video-urodynamic studies in children with non-neurogenic bladder sphincter dysfunction

Objective To ascertain the aetiology and epidemiology of non-neurogenic bla dder sphincter dysfunction (NNBSD) by assessing the results of prospective video-urodynamic studies (VUD) in 1000 children. Patients and methods During a 4-year study period (January 1995 to December 1998) 1000 children prospectively underwent VUD to further define their NN BSD. After a noninvasive screening assessment consisting of a history, void ing diary. clinical examination, urine analysis, ultrasonography and uroflo wmetry, those children who would benefit from further VUD were selected. Th e selection criteria included a history of urinary tract infection (UTI), a small bladder capacity not responding to training, dysfunctional uroflow, ultrasonographic abnormalities and resistance to therapy. During the study period 3500 children were screened for incontinence problems. including mon osymptomatic nocturnal enuresis; 1000 of these were selected for VUD (524 b oys and 476 girls). Results The urodynamic diagnosis was of normal bladder-sphincter function i n 62 (6.2%, male:female 44:56), urge syndrome in 582 (58%, 58:42). dysfunct ional voiding in 316 (32%,, 49:51) and 'lazy bladder' in 40 (4%, 20:80). Bo ys diagnosed with a 'lazy bladder' were younger than those with urge syndro me and dysfunctional voiding, Girls with dysfunctional voiding were younger than those with urge syndrome, The incidence of UTI was significantly high er in girls than in boys: boys with NNBSD had no greater risk for UTI and i n girls the general risk was 34%. Only in girls with a lazy bladder was the re a significantly higher incidence of UTI (53%). Reflux occurred equally i n all groups, with an overall incidence of 15%. The incidence of obstipatio n was significantly higher in girls with a lazy bladder. and overall was 17 %. Conclusion These results from a large series provide a new insight into the epidemiology and pathophysiology of NNBSD. The age distribution provides e vidence against a dysfunctional voiding sequence. The risk of developing UT I in NNBSD is greater only in girls. In children with a lazy bladder the ri sk is also significantly higher, indicating that residual urine is a greate r risk factor than detrusor instability. Urge syndrome and dysfunctional vo iding in girls carry the same risk for developing UTI, indicating that blad der instability is a higher risk factor for UTI than detrusor sphincter dis coordination. All dysfunctions carry an equal risk for developing secondary reflux. Children with NNBSD have different primary diseases but all have a common risk of incontinence. UTIs, reflux and obstipation.