Dysfunctional Voiding In Children: Two Case Reports Emphasizing Early Diagnosis And Prevention Of Upper Urinary Tract Damage
8th International Asklepios Congress On Medicine, Nursing, Midwifery, And Health Sciences, Priştine, Kosova, 12 - 14 Haziran 2026, ss.116-118, (Tam Metin Bildiri)
- Yayın Türü: Bildiri / Tam Metin Bildiri
- Basıldığı Şehir: Priştine
- Basıldığı Ülke: Kosova
- Sayfa Sayıları: ss.116-118
- Recep Tayyip Erdoğan Üniversitesi Adresli: Evet
Özet
ABSTRACT
Introduction: Dysfunctional voiding (DV) is a common but frequently underdiagnosed pediatric
voiding disorder characterized by inappropriate contraction of the urethral sphincter during voiding in
neurologically normal children. Delayed diagnosis may lead to bladder dysfunction, recurrent urinary
tract infections, vesicoureteral reflux, hydronephrosis, and permanent renal damage. We present two
pediatric cases with different stages of disease severity to highlight the importance of early diagnosis
and multidisciplinary management.
Case Presentations: Case 1: An 8-year-old girl presented with daytime urinary incontinence, nocturnal
enuresis, urgency, straining during voiding, constipation, and encopresis. Urinalysis, urinary
ultrasonography, and neurological examination were normal. EMG-assisted uroflowmetry demonstrated
a staccato and interrupted flow pattern with increased pelvic floor EMG activity during voiding,
consistent with dysfunctional voiding (Figure 1). Post-void residual urine volume was elevated (90 mL),
while the upper urinary tract remained unaffected.
Case 2: A 14-year-old boy presented with long-standing voiding difficulty, urinary incontinence,
nocturnal enuresis, constipation, and habitual urine holding. His medical history included hypospadias
repair and previous episodes of acute urinary retention. Ultrasonography revealed bilateral
hydronephrosis, bladder wall thickening, trabeculation, diverticula, and significant post-void residual
urine. Voiding cystourethrography confirmed severe bladder trabeculation and diverticula without
vesicoureteral reflux (Figure 2). Urodynamic evaluation demonstrated reduced bladder compliance,
phasic detrusor overactivity, reduced cytometric capacity, elevated detrusor leak point pressure, and
inappropriate sphincter activity during voiding (Figure 3). These findings were consistent with advanced
dysfunctional voiding, and Hinman syndrome was considered in the differential diagnosis.
Discussion: These cases demonstrate the broad clinical spectrum of dysfunctional voiding in children,
ranging from early-stage functional disturbance without upper urinary tract involvement to advanced
disease associated with bladder remodeling and upper tract deterioration. Both patients had concomitant
bladder-bowel dysfunction, an important contributing factor in pediatric lower urinary tract dysfunction.
The second case particularly illustrates the consequences of delayed diagnosis and prolonged voluntary
urine holding, including impaired bladder compliance and hydronephrosis. Non-invasive EMG-assisted
uroflowmetry is valuable in the initial evaluation, whereas invasive urodynamic studies may be
necessary in complicated or advanced cases. Early urotherapy, timed voiding, constipation treatment,
pelvic floor biofeedback, and multidisciplinary follow-up are essential to prevent long-term morbidity
and psychosocial impairment.
Conclusion: Dysfunctional voiding is a clinically significant pediatric condition that may result in
serious bladder and upper urinary tract complications if left untreated. Early recognition using
appropriate urodynamic assessment and timely multidisciplinary intervention are critical to preventing
irreversible urinary tract damage and improving quality of life.
Keywords: dysfunctional voiding, pediatric urinary incontinence, bladder-bowel dysfunction, pediatric
urodynamics, hydronephrosis, Hinman syndrome