Role of imaging for evaluation of voiding dysfunction and some related anatomic abnormalities

Role of imaging for evaluation of voiding dysfunction and some related anatomic abnormalities ۳% of ۵-۷ years old children experience diurnal incontinence. However, the incidence of an abnormal anatomic finding among all these children with bladder or bowel dysfunction is low ranging from ۱-۲%. Normal efficient voiding take place when the firing of the detrusor muscle is coordinated with the simultaneous relaxation of the striated external and the smooth muscle internal sphincters Bladder and rectum show shared sensory overlap (S۲, S۳,S۴) that accounts for the relationship between constipation and voiding dysfunction. Indications for imaging will vary according to the mode of presentation (incontinence vs infection) or known anatomic diagnosis such as spina bifida or spinal cord injury. Ectopic ureter and high grade reflux could be due to embryologic basis of far take off urethral bud from wolfian duct. Detrusor external sphincter dyssynergia can resemble PUV transiently at imaging too. Neurogenic bladder could be in DDx of bladder outlet obstruction, pelvic masses or multiple diverticula. Imaging a patient with dysfunctional voiding can provide findings that will allow an accurate diagnosis and lead to optimal management. Understanding in which patients to try imaging sooner versus trying medical and behavioral management is a function of experience. Some interesting cases are present in this lecture.