How is voiding dysfunction in children diagnosed?
If your child is experiencing a voiding problem, he or she will be referred to pediatric urology. Other members of the team might include behavioral psychologists, pediatricians, family practice physicians, and nurse practitioners.
Medical and social histories: The provider will take a history of your child's urination patterns and may ask you to create a voiding diary (to track frequency and volume). In addition, the doctor will ask about your child's bowel function (frequency, volume, caliber, staining, abdominal pain).
Physical and neurology exam: The provider will then conduct a thorough physical exam, including examination of the back, rectum and genitalia (for anatomic abnormalities). The neurologic exam will include careful attention to the lower extremities, including tone, strength, sensation, and reflexes.
Lab tests: A urinalysis, urine culture, and blood test (i.e., serum creatinine level) are conducted to gain an initial view of kidney function.
Other specialized tests: Certain radiologic and urodynamic tests (a test that provides details of bladder storage and emptying functions) may be ordered to help confirm the diagnosis and to document treatment effects. Other tests that may be ordered include:
- Renal and bladder ultrasound: Identifies obstructions in the urinary pathway and the capacity of the bladder
- Magnetic resonance image (MRI) of the lower spine: Identifies any spinal cord abnormalities
- Voiding cystourethrogram (VCUG): Special type of X-ray evaluates possible vesicoureteral reflux (the backward flow of urine from the bladder to the kidneys). This test is most often conducted in children with a history of urinary tract infections that are accompanied by a fever.
- Uroflow: Your child urinates into a special toilet that is used to get more information about the bladder and how he or she urinates.