What is non-neurogenic voiding dysfunction?

• Non-neurogenic voiding dysfunction is a condirtion in which children can’t fully empty their bladders. These children present with a mixed picture of storage lower urinary tract symptoms (frequency and urgency), voiding lower urinary tract symptoms, incontinence, recurrent urinary tract infections, incidental bladder wall thickening and / or hydronephrosis on imaging, and very occasionally with encoporesis

What is the difference between non-neurogenic and neurogenic voiding dysfunction?

• Non-neurogenic voiding dysfunction has no neurologic (nervous system) identifiable cause on MRI or investigations. It is  usually related to a weak bladder muscle, a blockage in the flow of urine, or habits that have developed over time.

What are the symptoms of non-neurogenic voiding dysfunction?

• Children and adults with non-neurogenic voiding dysfunction may experience:

  • Taking a while for urination to start, straining to pee, slow urine stream or flow that starts and stops.

  • Having to push with the stomach muscles, or push on the lower abdomen with the hands, in order to urinate.

  • Feeling like the bladder is never fully empty.

  • Constipation.

  • Frequent urination (more than six times a day in children), infrequent urination (fewer than three times a day) or leaking urine (urinary incontinence).

  • Holding behaviors, such as crossing legs or squatting (mostly in children).

  • Nocturia (urinating more than once per night).

  • Strong, sudden need (urge) to urinate.

  • Wetting during the day (mostly in children).

How is non-neurogenic voiding dysfunction diagnosed?

• It is diagnosed by history and examination and certain tests. Children are asked to keep a bladder diary to track daily urinating habits. TheThe child may get a blood test, urinalysis, ultrasound , MRI spine, MCU or urodynamic tests.

 What are the complications of non-neurogenic voiding dysfunction?

• Recurrent TI  and kidney damage are two major problems.

How is non-neurogenic voiding dysfunction managed or treated?

• Treatments for non-neurogenic voiding dysfunction in adults vary depending on the underlying cause. Treatments include:

  • Bladder training:

  • Pelvic floor therapy

  • Medications: Several medications improve voiding problems. Alpha blockers such as tamsulosin and  drugs for overactive bladder, such as oxybutynin and tolterodine may help.

  • Botulin toxin (Botox®) injections: Injection of  botulin toxins into the bladder to relax muscles, if you also have urge incontinence (strong urge to pee).

  • Sacral nerve stimulation: (InterStim™) by Medtronic is not approved by FDA for children less than 18 years

  • Self-catheterization

  • Patients who do not respond to conservative treatment, or sphincteric Botox injections, or in those with upper tract involvement and renal impairment, need to be considered for urinary tract reconstruction. the surgical options are

    • STING (sub-ureteric Teflon injection)

    • Ureteric reimplantation

    • augmentation cystoplasty and urinary diversion (formation of a Mitrofanoff channel

    • For patients with end stage renal failure, dialysis  and occassionally renal transplantation may be necessary.