Voiding disorders in severely mentally and motor disabled children

Purpose: We evaluated the voiding and continence patterns in severely menta lly and motor disabled children. Materials and Methods: The hetero-anamnestic, uroflometer and morning urine concentration profile results of 17 girls and 21 boys with severe mental a nd motor disability were evaluated in a prospective study. Results: Of the children 20 (52.7%) suffered daytime and/or nighttime wetti ng and 18 (47.4%) were continent. Daytime and nighttime wetting occurred in 85.7% of children with tetraparesis and in 66.6% of those with an IQ betwe en 46 and 55, representing the highest incidence rates. Bladder capacity wa s too small for age (mean deficit 145 ml.) in 92% of the children. Uroflowm etry demonstrated a dysfunctional pattern in 60.7% of patients. Dysfunction al voiding occurred in 100% of children with coordination disorders and in 87.5% of those with an IQ between 46 and 55, representing the highest incid ence rates. The morning urine concentration profiles showed an osmolality o f at least 1,021 mOsm./kg. in all cases. Conclusions: Although we found a remarkably high incidence of dysfunctional voiding, no correlation between the uroflow and continence patterns could be found. Restricted fluid intake, due to swallowing problems and insuffici ent hydration, causes an important bladder capacity deficit in most patient s. Becoming continent is determined by motor disability, especially the deg ree of mobility, rather than by mental development.