Urodynamics Program

Before you make an appointment with the Urodynamics Program, you will need a referral from your pediatrician, urologist, or another provider currently treating your child. Please have your referring physician contact us at 617-355-6171.

As you are scheduling your appointment, please ask the Urodynamics team which doctor will be there on the day of your visit. Unless it is a urologist who is already treating your child, you will need to call your insurance company and obtain a referral for the individual doctor, as well as for general urodynamics services at Boston Children’s Hospital.

Please be sure to let our team know ahead of time if your child has a history of heart or blood pressure problems. If your child is taking an antibiotic related to a heart condition, please ask your cardiologist whether it should be taken as usual before any urodynamics testing. If your child is on medication for a bladder function issue, please ask your pediatrician or urologist whether the medication should be taken before the urodynamics appointment.

Talk to your child in an age-appropriate way about what will happen at the appointment. Explain how the appointment will help them feel better over time.

If your child is toilet trained, please make sure they come to the appointment with a relatively full bladder.

Only one parent is allowed in the procedure room during testing, so please plan for the appointment accordingly. Cell phone use is not allowed during the procedure. Please call and ask to speak to one of our nurses at 617-355-6171 with any questions related to your child’s testing and or preparation for the procedure.

Please bring:

• A list of all prescription medications your child is taking
• Your insurance card
• A pacifier or bottle for infants
• Favorite books, toys, blankets, or music for older children
• We offer a variety of videos for your child to watch during certain tests

Depending on your child's particular symptoms, urodynamics procedures can be very simple (for example, a doctor or nurse observing the patient during urination to determine how long it takes for the bladder to empty and whether all of the urine is removed), or they can be more involved.

The most common types of simple procedures are:

• Bladder scan (also called a "focused ultrasound"). This uses a handheld sound wave device, placed over your child’s abdomen, to determine the amount of urine in the bladder before and after urination.
• Urinary flow rate, or "uroflow" (UF). This uses a special toilet connected to a computer to record the amount, pattern, and rate of urine flow.
• Uroflowmetry with skin patch electromyography (UF/EMG). This test uses sensors placed around the perineum (the area between the anus and the vagina or penis) to measure the activity of the muscles and nerves extending over the pelvis during urination

Sometimes your doctor may require a more invasive urodynamics test. If you have questions about the test before your appointment or if you have a child more sensitive to these types of tests, you can talk with our nurses to prepare your child.

These can include:

• Cystometrogram (CMG). This uses special tubes (called catheters) in the rectum and bladder to measure bladder pressure while filling with and emptying urine.
• Urethral pressure profile (UPP). This uses a thin, flexible tube (called a catheter) in the bladder to monitor the activity of the sphincter muscles when the bladder is filling up, emptying out, and completely empty.
• Full study. More rarely, if a child shows signs of a neurological problem, the care team may recommend a "full study" of the urinary sphincter. This means that in addition to a bladder and rectal catheter, an electrode is inserted into the external urinary sphincter muscle to monitor nerve and muscle activity. The child is examined by a neurologist.

In order for children to have normal urinary function, it is essential for them to fully relax their pelvic and urinary sphincter muscles. To help patients relax these important muscles, we use biofeedback, an innovative and noninvasive therapy approach that centers on a software program resembling a video game. First, skin patch electrodes (similar to a sticker or bandage) are placed on the perineum (area between the anus and genitals) and abdomen to measure the child’s state of relaxation. Patients then perform fun yet challenging exercises: When a child successfully relaxes his or her muscles, they launch and land computer-generated rocket ships or open and close blooming flowers.

To make sure that your child's appointment will be covered by your insurance plan, call your referring doctor's office, your insurance company, or both before the appointment. If you have any additional questions about coverage, please call your insurance company using the phone number on the back of your insurance card.

For billing questions, please call Outpatient Billing at 617-355-3397.