Dysfunctional Voiders-Medication Versus Urotherapy?

[PURPOSE OF REVIEW] Dysfunctional voiding is defined as "habitual contraction of the urethral sphincter during voiding." Children with dysfunctional voiding remain a challenge, and the approach to and management of LUT dysfunction varies widely among programs and providers with the role of pharmacotherapy being ill defined.

[RECENT FINDINGS] Animated biofeedback is the current treatment modality of choice in children who are not responsive to standard urotherapy. Comprehensive biofeedback programs incorporate continued elimination education, voiding diaries, and home exercises with high success rates. Recent studies suggest botulinum toxin A results in persistent satisfactory results in select children with refractory dysfunctional voiding. Conservative measures including an aggressive bowel regimen and timed voiding are the mainstays of treatment, and motivated children with persistent symptoms often respond favorably to escalating urotherapy with biofeedback. Pharmacotherapy plays an ancillary role in the management of dysfunctional voiding.