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Helping Children with Voiding Disorders

New York, NY (Sep 25, 2009)

Toddler in red dress

In the Linda and Carl Seaman Pediatric Urodynamics Unit at the Komansky Center for Children's Health, pediatric urologists are enhancing the screening, treatment, and monitoring of children who have urological difficulties – from bedwetting to complex voiding disorders.

Voiding disorders in children are quite varied, with issues that go much beyond nighttime bedwetting. "Parents bring their children to see us for a number of reasons," says Carlos Medina, MD, Director of the Linda and Carl Seaman Pediatric Urodynamics Unit. "Symptoms range from incontinence and frequent urination to pain during urination and recurrent urinary tract infections."

A graduate of Weill Cornell Medical College, Dr. Medina became interested in pediatric urodynamics during his pediatric urology fellowship at the University of California, San Diego. "During my training in San Diego, I participated in a spinal defects multidisciplinary clinic and realized that one of the services severely lacking for children with spinal disorders was pediatric urodynamics," says Dr. Medina. "That was always one of the areas that was near and dear to my heart."

Dr. Medina returned to Weill Cornell in 2008, developing the urodynamics program into a comprehensive service for children with voiding disorders and an important referral center for patients with bladder issues secondary to another condition.

What Can Cause a Pediatric Voiding Disorder?

Pediatric voiding dysfunction may be the result of:

  • congenital spinal cord defects
  • spinal cord injury
  • cerebral palsy
  • bladder augmentation or reconstructive surgery

"For example," says Dr. Medina, "a child who has injured their spinal cord may have a problem affecting the nerves that go to the bladder. The bladder problem can actually change – for better or worse – as the patient gets older so it is important to monitor bladder function regularly. Our long term goal in these circumstances is to save the kidneys. If the kidneys experience too much pressure due to increased bladder pressure they can become damaged or impaired leading to the need for transplant. We know that by optimizing certain medications and performing surgery, if indicated, that we can prevent these patients from needing transplantation."

Urodynamics screening and monitoring also benefit children who have had surgery for pelvic cancer. They may be at risk for bladder problems as a result of a manipulation during surgery that can damage the nerves to the bladder.

"In addition, about 30 percent of children with cerebral palsy (CP) will have bladder conditions," notes Dr. Medina. "Many of these children are unable to communicate their problem and therefore go without treatment or have treatment delayed. "If you can diagnose a problem early and treat with the appropriate medications, you may be able to avoid surgery and prevent them from having lifelong problems."

Dr. Medina also notes that baseline urodynamic studies provide valuable information to neurosurgeons and spine surgeons who often operate on nerves that involve the bladder, enabling them to track bladder issues pre and post surgery.

What Does a Urodynamics Assessment Involve?

The Seaman Pediatric Urodynamics Unit provides a calming environment for children to minimize their anxiety and facilitate diagnosis and treatment. A urodynamics evaluation enables us to determine the status of the bladder and urethra, providing valuable information about bladder pressure, capacity, and voiding pressure. The evaluation can include:

Bladder Pressure Study to evaluate the stability of the bladder, how much pressure builds in the bladder as it fills with urine, and whether the bladder is having involuntary contractions.

Video Urodynamics Study to determine if there are anatomic abnormalities in the bladder and urethra through the use of multiple X-ray images can be taken of the shape of the bladder or urethra while the bladder is filling.

Pressure of Flow Test to measure voiding pressure during urination.

Leak Test to measure the electrical activity of the muscles which prevent leaking.

Biofeedback Uroflow Study to test the volume and rate of urine flow per second. After completion of this test, we perform an ultrasound, which is done right in the unit, to determine if the patient is able to empty their bladder appropriately.

What treatments are available to manage a voiding disorder?

"If a urodynamics study reveals a voiding disorder, we first try to manage patients conservatively," says Dr. Medina. "If the child has a bladder that has too much pressure, the intervention typically begins with an anticholinergic medication to relax the bladder and relieve symptoms, such as frequent or urgent urination, incontinence, and increased nighttime urination."

Patients who have a voiding dysfunction related to a spinal disorder or neurological problem will be managed with medications and followed regularly as they get older. "If their condition progresses and we have exhausted all of our conservative measures, we begin to consider surgical intervention," says Dr. Medina. This may include bladder augmentation in which the bladder is made larger using a portion of the intestine to increase its capacity.

If the patient is having reflux – a condition in which urine backs up into the kidneys due to incorrect positioning of the ureter, treatment options range from a deflux injection to surgery to reimplant the ureter in a normal position.

Bladder neck reconstruction may be indicated to address a leaking problem in patients with inadequate muscle tone at the base of the bladder.

Institute for Pediatric Urology

The Institute for Pediatric Urology of the Komansky Center for Children's Health in the Department of Urology at NewYork-Presbyterian Hospital/Weill Cornell Medical Center provides management of complex genital and urinary problems that occur in children, from birth to 18 years of age. The Institute is an internationally recognized referral service for the treatment of children with ambiguous genitalia and has pioneered laparoscopic and robotic surgery procedures for bladder and kidney disorders. In addition to the Seaman Pediatric Urodynamics Unit, the Institute of Pediatric Urology has a Pediatric Stone Unit and a program for fetal urology in collaboration with the Department of Obstetrics and Gynecology. Dr. Dix Poppas, Chief of Pediatric Urology, performed both the first robotic pyloplasty and the first laparoscopic nephrectomy in New York in children. He serves as Director of the Laboratory for Minimally Invasive Urologic Surgery, overseeing clinical applications for new techniques and instrumentation used in minimally invasive surgery.

Information and Referral

If you would like more information on the Linda and Carl Seaman Pediatric Urodynamics Unit, please call (212) 746-5361.

Linda and Carl Seaman Pediatric Urodynamics Unit
Komansky Center for Children's Health
NewYork-Presbyterian Hospital/Weill Cornell Medical Center
525 East 68th Street, Ninth Floor, F-935
New York, NY 10065
(212) 746-5361

Contributing faculty for this article:

Dix P. Poppas, MD, Director, Institute for Pediatric Urology, Komansky Center for Children's Health, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Professor of Urology, Professor of Urology in Obstetrics and Gynecology, Professor of Urology in Pediatrics, Rogers Family Foundation Professor of Pediatric Urology, Weill Cornell Medical College.

Carlos Medina, MD, Director, Linda and Carl Seaman Pediatric Urodynamics Unit, Institute for Pediatric Urology, Komanksy Center for Children's Health, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and Assistant Professor of Urology, Weill Cornell Medical College.

The creation of the Linda and Carl Seaman Pediatric Urodynamics Unit was made possible by an endowment established by the Seaman family.

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