Voiding Dysfunction (VD) disorder is not characterized by a neurological cause but only for sphincter dysfunction during bladder voiding. Congenital and genetic conditions likely feature a multifactorial etiology. The set of clinical manifestations is composed by decreased urinary frequency, increased residual urine after voiding, incontinence and urinary tract infection. Children with Voiding Dysfunction may benefit from urotherapy: it’s a behavioral approach to rehabilitation, a non-surgical treatment for lower urinary tract dysfunction. The first line treatment is different between adult and children: for adult first line is training with pelvic floor physiotherapy and biofeedback; for children urotherapy is considered first line of treatment.[1] The aim of this study is to evaluate the effectiveness of urotherapy in children with Autism Spectrum Disorders (ASD) and cognitive impairment.

23 patients referred to our hospital over a ten years period, diagnosed Voiding Dysfunction and exhibiting ASD or cognitive impairment were included in the study. Patients with positive neuroimaging and neurophysiological examination were excluded. At diagnosis patients were between 4 and 16 years old with an average of 8.5 years. These 23 patients consisted of 13 males (56,5%) and 10 females (43,5%). Nine patients (39,1%) had pervasive developmental disorders (5 with ASD, 1 with ADHD, 1 with learning disabilities and 1 with unspecified pervasive developmental disorder), five (21,7%) had cognitive impairment and the remaining nine children (39,1%) had various diagnoses, including genetic and cerebrovascular disorders. Therapy of children with Voiding Dysfunction is a behavioral approach with a support of a Frequency-Volume Chart (FVC) to acquire voiding frequency and corresponding urine volume. FVC analysis allow recommendations for appropriate and regular voiding. After diagnosis follow up is important at 6 and 12 months.

65% of patients showed improvement after 6 months therapy and 15 patients after 1 year. After 6 months 4 of 23 patients had complete resolution of symptoms and one of these maintained symptom relief after one year. On the other hand, only 1 child showed worsening of urinary incontinence after one year.

Behavior indication and use of FVC in Voiding Dysfunction improve quality of life, reducing cost and avoiding more invasive procedures in a significant percentage of children. Voiding Dysfunction is a complex condition, its management needs time and active cooperation and adhesion of patients and their family.

Rehabilitation of pediatric patients with Voiding Dysfunction can be achieved with a simple behavioral approach. It is important to encourage pediatricians and families to consider urotherapy. Although this approach requires family compliance and a long treatment duration, children can achieve excellent outcomes and gain important support and reassurance in their educational journey.

Frank-Jan van Geen, Eline H.M. van de Wetering, Anka J. Nieuwhof-Leppink, Aart J. Klijn, Laetitia M.O. de Kort. Dysfunctional Voiding: Exploring Disease Transition From Childhood to Adulthood.