İ NONINVASIVE EVALUATION OF THE CHILDREN WITH LOWER URINARY TRACT DYSFUNCTION

Introduction: Lower urinary tract dysfunction in children appears due to wrong acquired voiding habits during toilet training period. Recent reports suggest noninvasive diagnostic tests in the primer evaluation of these patients. The purpose of this study suggests that initial evaluation of these patients should be done with noninvasive methods. Materials and Methods: Between January 2004 and July 2006, 189 patients with lower urinary system dysfunction who admitted to pediatric urology department were included to the study. Detailed history, physical examination, urine analysis, urine culture, serum biochemical analysis including serum urea, creatinine, glucose and uroflow-EMG, lumbosacral graphy, urinary system USG with residual urine volume were performed to all patients. Voiding dysfunction symptom score (VDSS) was also asked to fulfill by the all patients. According to the first evaluation, the patients with lower urinary system dysfunction were divided into three groups; dysfunctional voiding, overactive bladder and underactive bladder. Mean follow-up durations of patients are 6.8 (6-12) months. Results: One hundred sixty of 189 patients (84.7%) were diagnosed as dysfunctional voiding. Staccato voiding pattern in uroflow-EMG was detected in 138 of 189 patients (86.2%). Normal voiding patterns were detected in 22 (13.8%) patients. Vesicoureteral reflux (VUR) was diagnosed in 29 patients. Tower voiding pattern was determined in 23 (12.1%) patients and these were diagnosed as overactive bladder. VUR was diagnosed 2 of these 23 patients. Six (3.1%) patients diagnosed as underactive bladder according to their interrupted voiding patterns in uroflow-EMG. VUR was detected in 4 of these patients. Conclusion: During the evaluation of the children with lower urinary system dysfunction, complete evaluation with history, physical examination, urine analysis, urine culture, uroflow-EMG, urinary system USG with residual urine volume and VDSS seems enough. Due to higher costs and invasiveness, cystometry, voiding cystourethrography and the further diagnostic tests, should be performed in the refractory cases and if the upper urinary system is deteriorated.

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