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Urology

Comprehensive Diagnostic and Treatment Services

The Center for Urodynamics and Incontinence is one of the few facilities available where children with incontinence can go for comprehensive testing and treatment, particularly for studies that can obtain X-ray images of the bladder, simultaneously recording bladder pressure measurements in what is called a video urodynamic examination. Patients suspected of having serious bladder problems, or known to have spina bifida, cerebral palsy or wetting problems in association with a condition called vesicoureteral reflux are more likely to have this evaluation. The Center treats approximately 200 children with spina bifida each year and prides itself on its proactive mission to prevent permanent bladder damage in these children and/or to avoid later procedures such as bladder augmentation or bladder neck surgery.

Many parents and even some pediatricians are surprised to hear the root of the problem is physical and not psychological. Identifying the physical source takes time, since children with nearly identical symptoms may have completely different underlying disorders, each with its own therapeutic regimen. The most common problem among these children is the tendency to squeeze their pelvic floor muscles during urination when they should be relaxing them. The bladder muscles contract normally to expel urine. When the pelvic floor muscles tighten up at the same time, it becomes difficult for the bladder to empty. Some children are actually playing a tug-of-war with the bladder and the pelvic floor muscles. The result is a bladder that does not empty, resulting in an increase in the bladder pressure, and then another urgent trip to the bathroom.

Using a variety of biofeedback techniques including computerized games, our physician assistant and nurse practitioners teach children how to control and coordinate their muscles during urination. In as few as three one-hour biofeedback sessions, the problem of uncoordinated voiding can be corrected. It is very satisfying to see children leave the Center dry with newly restored self-esteem.