Using an electronic uroflow metre to identify the causes of dysfunctional voiding in children
Posted by Karen Radford on in enuresis, incontinence treatment, paediatric continence, primary nocturnal enuresis, uroflow metre, urology
Note: Promocon is now known as Bladder and Bowel UK
I recently attended the Promocon paediatric continence group meeting in Manchester where there was a practical demonstration of how to analyse and identify the causes of dysfunctional voiding in children using an electronic Uroflow Metre.
Uroflowmetry is used to test the amount of urine and the speed of urination which in turn can help identify the cause of dysfunctional voiding. A uroflowmeter calculates the amount of urine passed, the flow rate in seconds, and the length of time it takes to empty the bladder completely and records this information on a chart. During normal urination, the initial urine stream begins slowly, speeds up, and then finally slows down again. The uroflowmeter can record any differences from the norm to help with diagnosis.
A daily diary is kept of the child’s drinking habits (amount and timing), toilet visits (measured by the Uroflow Metre), frequency and consistency of bowel movements, and all wetting events. This builds a picture of the child’s hydration levels, bladder capacity (age x 30+30ml being the age appropriate capacity) and possible constipation issues.
If a child with dysfunctional voiding has normal flow and there is no urinary tract infection, then a behavioural intervention programme is usually indicated, e.g. the use of a bedwetting alarm in the case of primary nocturnal enuresis.
On the other hand, an abnormal flow with pre- and post-void scans to establish if voiding is complete or not, would indicate one or more of the following treatment paths:
Introducing an appropriate fluid intake programme can assist with bladder stretching in children with small capacity and those with twitchy or overactive bladders whose hydration levels are insufficient. It may also assist with any constipation issues that are identified.
Toilet posture and relaxation techniques along with a regular toileting programme may prove useful for those children who suffer incomplete voiding, overactive bladders and constipation.
The use of Uroflowmetry assists in the identification of the underlying causes of dysfunctional wetting in children which, in turn, can lead to improved treatment programmes. This has to be a worthwhile investment for paediatric incontinence treatment!