Overactive Bladder During Childhood: When and How It Should Be Treated

Home , Frequent urination, Overactive bladder

Incont Pelvic Floor Dysfunct 2010; 4(1):13-17 Review

Overactive Bladder during Childhood: When and How It Should Be Treated

Yi-Sheng Chen, M.D.1, Stephen Shei-Dei Yang, M.D.2, Shang-Jen Chang, M.D.2 Department of Urology1, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan; Division of Urology2, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

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ÅÉéíçê=ïÜáÅÜ=áë=~Åíáî~íÉÇ=Äó=Å~éë~áÅáåI=éìêáåÉêÖáÅ=êÉÅÉéíçê=ïÜáÅÜ=áë ÅÜáäÇêÉå=ï~ë=RKROB=xUzK=qÜÉ=êÉëìäíë=ïÉêÉ=ëáãáä~ê=íç=íÜçëÉ=êÉéçêíÉÇ=áå ~Åíáî~íÉÇ=Äó=^qmI=~åÇ=åÉìêçâáåáå=êÉÅÉéíçê=ïÜáÅÜ=áë=~Åíáî~íÉÇ=Äó=ëìÄJ ïÉëíÉêå=ëçÅáÉíáÉëK=båìêÉëáë=ï~ë=ëáÖåáÑáÅ~åíäó=ãçêÉ=Åçããçå=áå=Äçóë ëí~åÅÉ=mI=åÉìêçâáåáå=^I=~åÇ=åÉêîÉ=ÖêçïíÜ=Ñ~Åíçê=EkdcF=êÉÅÉéíçêK íÜ~å=áå=Öáêäë=ETKQB=îÉêëìë=QKPNBFK=få=~ÇÇáíáçåI=~äíÜçìÖÜ=íÜÉ=éêÉî~äÉåÅÉ qÜÉ=áåíÉê~Åíáçå=çÑ=ÇáÑÑÉêÉåí=åÉìêçíê~åëãáííÉêë=~åÇ=åÉìê~ä=é~íÜï~óë áë=îÉêó=ÅçãéäÉñK=^åó=áãÄ~ä~åÅÉ=ÄÉíïÉÉå=íÜÉã=ã~ó=äÉ~Ç=íç=l^_K=qÜÉ Received: July 30, 2009 Accepted: August 11, 2009 Éñ~Åí=é~íÜçéÜóëáçäçÖó=çÑ=l^_=ëíáää=åÉÉÇë=íç=ÄÉ=áåîÉëíáÖ~íÉÇK Address correspondence to: Dr. Shang-Jen Chang, Division of Urology, Buddhist Tzu Chi General Hospital, Taipei Branch, 289, Jianguo Road, Sindian, Taipei, Taiwan E-mail: [email protected]

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NQ Review

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NR Review

Patients complain of urgency with or without urge incontinence, frequency, or nocturnal enuresis

History taking: the severity and voiding condition (voiding diary, DVSS*), the bowel habit, the developmental condition, underlying urological, neurological and psychological disorders, the current medication

Physical examination and neurological examination Urine culture, serum Na/Cr, thirst test, 4 Abnormal spots vasopressin level, abdominal x-ray, and VCUG Urinalysis, urine specific gravity, and renal ultrasound Normal Treat infection and diabetes insipidus, and Uroflowmetry: the voiding volume, the flow pattern, correct anatomical anomaly and peak flow rate Bell-shaped curve No abnormality in the voiding function Nonbell-shaped *VCUG, conventional urodynamic study ± EMG or video urodynamic study ± EMG Anticholinergics

Alpha-blockers

No bladder outlet obstruction Bladder outlet obstruction Biofeedback therapy for dysfunctional voiding

Surgical relief for anterior/posterior urethral valve and primary bladder Conventional treatment for Failed neck dysfunction OAB: biofeedback therapy, Alpha-blockers, Botulinum-A anticholinergics, treatment toxin injection for constipation

*DVSS = dysfunctional voiding symptom score VCUG = voiding cystourethrography

Fig. 1. The flowchart for the diagnosis and treatment for pediatric OAB. (VCUG, urodynamic study ± EMG, and videourodynamic study ± EMG were performed when the anatomical obstruction was suggested, or the responsiveness to conventional OAB treatment was poor)

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