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In the name of god. Voiding dysfunction. Up to 40% ped.urol.clinic visits 15-50% of VUR patients 4-6% daytime wetting in 7 years old Expecting daytime dryness 4 years. Ectopic ureter. Epispadias. Before treatment creatinine 3.1 mg %. After treatment creatinine 1.1 mg %. Reflux .
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Voiding dysfunction Up to 40% ped.urol.clinicvisits 15-50% of VUR patients 4-6% daytime wetting in 7 years old Expecting daytime dryness 4 years
Before treatment creatinine 3.1 mg % • After treatment creatinine 1.1 mg %
Reflux F.E 2.5 month Before STING • After STING
Evaluation History Ph.Exam Voiding Dairy UTI Fecal Problem
Ph.Exam Sacral Malformation Lipoma Hemangioma Hairy patch asymmetry
Ph.Exam Rectal Tone Perineal Sensation MeatalStenosis Labial Adhesion Neurologic Exam
Evaluation Lab Sono KUB-VCUG MRI(any suspicious of neurologic dysfunction) Flow-EMG CMG-EMG
UDS Neurologic Disease Renal Damage Imperforated Anus Some Anomalies such as PUV V.D. refractory to conservative treatment
Treatment Constipation(30-90% in V.D) Eliminate irritants(caffeine,chocolate,juice,tomato and spicy foods.) Perineal and genital irritation Time voiding , Double voiding
Pharmecoherapy 40-70% efficacy Anticholinergic Ditropan Detrositol Alpha blockers
Psychologic consult Attention deficit Learning Disorder Family Problem Child abuse
CIC Botox to 70% improvement TENS in selected cases of OAB Augmentation
prognosis Mostly favorable upto 90%