From the Guidelines
The treatment approach for a patient with urodynamic study (UDS) findings indicating dysfunctional voiding should begin with behavioral modifications and pelvic floor physical therapy, with a focus on education, timed voiding, and proper toileting posture. The initial steps in managing dysfunctional voiding involve educating the patient and their family about bladder and bowel dysfunction, timed voiding, adequate fluid intake, and aggressive management of constipation and hygiene issues 1. Key aspects of treatment include:
- Correct toilet posture with buttock support, foot support, and comfortable hip abduction to enable a sitting posture that does not activate abdominal muscles and simultaneous co-activation of pelvic floor musculature 1
- Pelvic floor physical therapy with biofeedback to help patients identify and properly relax their pelvic floor during voiding, which may be enhanced by uroflow pattern, auditory stimulus, or noninvasive abdominal or perineal EMG as biofeedback 1
- Management of constipation, which is usually treated with initial disimpaction with oral laxatives ideally followed by a maintenance phase of ongoing bowel management in conjunction with a toileting program 1 Pharmacotherapy may be considered in some cases, such as the use of alpha-blockers to reduce outlet resistance or anticholinergics to manage overactive bladder symptoms, but this should be approached with caution and careful monitoring of treatment outcomes 1. It is essential to address any underlying psychological factors that may contribute to pelvic floor dysfunction, such as anxiety or past trauma, and to involve a multidisciplinary team in the patient's care, including a psychologist and other healthcare professionals as needed. Treatment success depends on patient adherence and a comprehensive approach that incorporates behavioral modifications, physical therapy, and pharmacotherapy as needed, with regular monitoring of treatment outcomes and adjustments to the treatment plan as necessary.
From the Research
Treatment Approach for Dysfunctional Voiding
The treatment approach for a patient with urodynamic study (UDS) findings indicating dysfunctional voiding involves a combination of conservative management and pharmacological interventions.
- Biofeedback Pelvic Floor Muscle Training (PFMT): Biofeedback PFMT has been shown to be effective in improving clinical symptoms, quality of life, and uroflowmetry parameters in patients with dysfunctional voiding 2.
- Conservative Urotherapy: Conservative urotherapy, including timed voiding and constipation treatment, is often used as an initial management strategy for patients with dysfunctional voiding 3, 4.
- Alpha-Blocker Therapy: Alpha-blocker therapy has been found to be a viable alternative to biofeedback for dysfunctional voiding and urinary retention in children 5.
- Combination Treatment: Combination treatment with biofeedback and alpha-blockers can be used as additional therapy in refractory cases 5.
- Pelvic Floor Physical Therapy: Pelvic floor physical therapy is a worldwide accepted therapy that has been used to manage many pelvic floor disorders, including non-neuropathic voiding dysfunction in children 6.
Evaluation and Diagnosis
The evaluation and diagnosis of dysfunctional voiding involve a careful examination and history, with further imaging including a renal ultrasound and uroflowmetry to confirm the diagnosis 4.
- Urodynamic Study (UDS): UDS is a valuable tool in the diagnosis and management of dysfunctional voiding, providing information on bladder and urethral function 3.
- High-Risk Markers: High-risk markers, such as hydronephrosis, vesicoureteral reflux, renal failure, or marked voiding difficulty, should prompt a formal urodynamics evaluation and imaging for neurological etiology 3.