Exploring dysfunctional voiding in girls: a comprehensive literature review of assessment and management strategies

Abstract

Dysfunctional voiding (DV) is a multifactorial functional problem that refers to dysfunction during voiding. DV is clinically important because it increases the risk of urinary tract infections, mostly due to incomplete bladder emptying, and unfavorably affects renal function. Additionally, a child with DV may experience storage symptoms such as frequency and wetting, which can significantly impact the child’s quality of life. There is also a correlation between DV with bowel dysfunction and behavioral disorders. Girls with external urethral meatus anomalies, like hypospadias and/or meatal web, are more prone to complications related to DV. Therefore, girls exhibiting DV symptoms should also be evaluated for meatus anomalies. These patients often contract their external urethral sphincter and pelvic floor musculature, leading to voiding problems. Successful treatment involves applying appropriate diagnostic approaches. In girls with DV, urotherapy and biofeedback are considered gold standard modalities for retraining pelvic floor muscle function synchronously and properly. Although new emerging techniques such as stem cell therapy could improve urinary incontinence in adults and animal models with damaged external urethral sphincters, there is currently a lack of evidence regarding its therapeutic potential for children with DV.