Abstract

Non neurogenic bladder dysfunctions make up around 30-40% of pediatric urology outpatient cases. In neurologically normal children, lower urinary tract dysfunction is divided into pathologies involving the filling or emptying phase. Overactive bladder, functional urinary incontinence and giggle incontinence involve the filling phase while dysfunctional voiding, lazy bladder, Hinman syndrome and dribbling after voiding involve the emptying phase of the lower urinary tract dysfunctions.. The most frequently seen urinary system dysfunction is overactive bladder which is caused by involuntary detrusor contractions. It is characterised by urgency. In functional incontinence, normal continence can not be maintained by the sphincter mechanism. Giggle incontinence is almost always seen in girls and is characterised by involuntary incontinence seen during laughing or giggling. Dysfunctional voiding where the sphinter mechanism abnormally contracts during emptying due to a bladder-sphincter dysfunction, is generally accepted as being an acquired disorder. In lazy or hypoactive bladder, there is complete loss of detrusor activity and voiding requires application of Valsalva maneuver. Complete decompensation of the voiding mechanism is observed in Hinman syndrome which is also called hidden neuropathic bladder. There are several treatment options for lower urinary system dysfunctions. Urotherapy is the first- line treatment option in all patients and aims for good toilet training. Anticholinergic medications decrease or prevent uninhibited detrusor contractions. Alpha- adrenergic antagonists relax the detrusor smooth muscle and sphincter leading to decreased bladder outlet resistance. The benefit of prophylactic antibiotics has been proven in patients with recurrent UTI. Botulinum toxin A acts by leading to a reversible flaccid paralysis of muscles. In detrusor- sphincter coordination disorders such as OAB and DV, biofeedback is a modality that aims to teach the patient correct and effective use of pelvic floor muscles during voiding. Sacral nerve or percutaneous tibial nerve stimulation exerts its effect through modulation of neural pathways. Clean intermittent catheterisation is a treatment option in patients with neuropathic or decompensated bladders or where significant residual urine is left after voiding.