First, the child should always be evaluated by a pediatric urologist.
For children with urinary incontinence only:
- Children with enuresis (urinary incontinence)and no known anatomic or neurological abnormalities may need to be referred to Urodynamics when other methods of treatment, including a combination of drugs and behavioral modification strategies to help achieve dryness, have failed to correct the problem.
Children with recurring urinary tract infections:
- Children with recurring urinary infection are usually referred to Urodynamics after they have been on continued long-term antibiotics, but are still having episodes of incontinence or recurring infections
Alternatively, these children may be referred to Urodynamics when X-ray imaging reveals particular abnormalities of the bladder after they have experienced multiple urinary infections.
Children with neurological conditions:
- In most cases, children with neurological conditions, such as spina bifida, should be referred to Urodynamics during the newborn period.
- These infants' doctors will also want to use urodynamics testing to assess their urological status. This is because, as the child grows, there may be progressive changes in the neurological function of the bladder, stemming from pressure or stretching of the spinal cord. As a result, or especially if there are concerns regarding the spinal cord, urodynamics tests are typically repeated periodically.
- Referral to Urodynamics is also advisable when these children are older if they have not achieved continence on their own, or if recurring infections are a problem. They may benefit from simple measures like intermittent catheterization and medications that allow the bladder to function normally.
Children with anatomical conditions:
- Referral to Urodynamics may be indicated when imaging tests (such as ultrasound or X-ray) reveal changes in the appearance of the upper urinary tract that suggest an alteration in bladder function.
- In children with other anatomical conditions that lead to incontinence, such as bladder exstrophy/epispadias or anorectal malformation, Urodynamics referral becomes necessary early on. It is also important to follow the child’s progress during growth.
- Urodynamics will continue to be of great benefit in deciding on means of therapy and improving the efficiency of a child's overall treatment plan.