Voiding disorders in childhood: from symptoms to diagnosis

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie 2012-11, Vol.19 (11), p.1231-1238
• Main Authors: Bréaud, J, Oborocianu, I, Bastiani, F, Bouty, A, Bérard, E
• Format: Article
• Language: fre
• Subjects: Child; Child, Preschool; Constipation - complications; Constipation - diagnosis; Constipation - therapy; Diagnosis, Differential; Enuresis - diagnosis; Enuresis - etiology; Enuresis - therapy; Female; Humans; Infant; Male; Muscle Hypertonia - diagnosis; Muscle Hypertonia - etiology; Muscle Hypertonia - therapy; Physical Examination; Referral and Consultation; Risk Factors; Surveys and Questionnaires; Urethral Diseases - diagnosis; Urethral Diseases - etiology; Urethral Diseases - therapy; Urinary Bladder, Overactive - diagnosis; Urinary Bladder, Overactive - etiology; Urinary Bladder, Overactive - therapy; Urinary Incontinence - diagnosis; Urinary Incontinence - etiology; Urinary Incontinence - therapy; Urination Disorders - diagnosis; Urination Disorders - etiology; Urination Disorders - therapy
• ISSN: 1769-664X
• DOI: 10.1016/j.arcped.2012.08.002

The new definitions of voiding disorders in children should be used in clinical practice. Two major kinds of voiding disorders are identified: 1) isolated primary enuresis as a disorder occurring exclusively during sleep with no daytime leakage; 2) urinary dysfunctions that include uninhibited detrusor contraction, sphincter hypertonicity, and urethral instability. These dysfunctions may be primary or secondary. Constipation as an underlying cause is frequent and usually underestimated. The diagnostic process requires one (or more) long consultations. After ruling out a urine leak without a voiding disorder and secondary causes (constipation, inadequate hydration, poor voiding hygiene, crystalluria, etc.), the aim is to distinguish isolated sleep-time disorders (primary enuresis) from daytime ± sleep-time symptoms (primary urinary dysfunctions). Anamnesis, long and accurate, can be sensitized by a questionnaire completed at home. The physical examination focuses on the exclusion of anatomic abnormalities and local inflammation (vulvitis, balanitis, etc.). Diagnostic tests are rarely required at the beginning. Urodynamic exploration may be indicated, never at the first consultation, in case of primary urinary dysfunction. This diagnostic approach provides an appropriate therapeutic decision.