Clinical Evaluation: History Taking and Urological, Gynaecological and Neurological Evaluation
Most children referred for urodynamic studies already have specific pathological diagnoses such as spinal dysraphism, spinal cord injury or cerebral palsy as well as voiding dysfunction. When paediatric urologists need to evaluate a child, an understandin
- PDF / 214,985 Bytes
- 10 Pages / 439.37 x 666.142 pts Page_size
- 62 Downloads / 419 Views
Clinical Evaluation: History Taking and Urological, Gynaecological and Neurological Evaluation Cevdet Kaya and Christian Radmayr
2.1
Introduction
Paediatric urology practice encompasses a spectrum of disorders from complex congenital anomalies to more routine but important problems such as voiding dysfunction (LUTD) in a school-aged child. The evaluation process of a child with LUTD should begin with a good history consisting of perinatal issues, developmental milestones, current mental status, scholastic performance, nature of toilet training, bladder and bowel emptying patterns and frequency, timing and severity of incontinent episodes. The second important step is the physical examination, a careful inspection of the lower spine to identify possible cutaneous manifestations of an occult spinal dysraphism and/or sacral agenesis, an assessment of the lower extremity function and an examination of the external genitalia, respectively. The development of lower urinary tract function requires maturation of the neural system. The process of having control over the bladder and sphincter function is complex, and therefore highly susceptible for the development of various types of dysfunction [1]. While the normal bladder function is usually gained during the second year of life, the child becomes able to express a need to void, initiate a void and inhibit micturition if needed during the third and fourth year of life. Eventually, a healthy school child voids less than seven times per day, and most of them empty their bladders completely. The overactive bladder with normal micturition, dysfunctional voiding with staccato pattern and detrusor underactivity with significant residual urine comprise the main clinical patterns of LUTD in children. In response to the uninhibited contractions during toilet training, many children learn to contract C. Kaya, M.D. Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey C. Radmayr, M.D. (*) Department of Urology, School of Medicine, Innsbruck University, Innsbruck, Austria e-mail: [email protected] © Springer International Publishing AG, part of Springer Nature 2018 G. Mosiello et al. (eds.), Clinical Urodynamics in Childhood and Adolescence, Urodynamics, Neurourology and Pelvic Floor Dysfunctions, https://doi.org/10.1007/978-3-319-42193-3_2
11
12
C. Kaya and C. Radmayr
their sphincters to avoid wetting, and many of these can develop a form of urge syndrome as they learn to overcome the urge and voiding by sphincter contractions and different holding manoeuvers like squatting. Giggle incontinence is characterized by large-volume voiding that occurs while laughing and no voiding symptoms between these episodes. On the other hand, vaginal voiding is more likely to occur in obese girls and characterized as incontinence when standing up after voiding because of temporarily trapped urine in the vagina. The neurologic causes of lower urinary tract dysfunction originate from a group of spinal abnormalities. The open spinal canal lesions, mening
Data Loading...
