Non-neurogenic voiding dysfunction (VD) is a common health problem that represents more than one-third of outpatient pediatric urology encounters. Nevertheless, clinical diagnosis has not been standardized. Several questionnaires have been proposed to quantify the severity of symptoms and monitor treatment progress. However, these questionnaires are time-consuming and there is a large amount of heterogeneity in the validation process of these questionnaires with no consensus on the gold standard questionnaire. We assume that patients with VD have some degree of dehydration and their hydration status affects their VD symptom severity. This study aimed to assess whether urine color on a validated urine color scale, as a surrogate for hydration status, correlates with the severity of VD symptoms.

This was a prospective observational study that included 29 patients < 18 years presenting with symptoms of VD. A total of 21 healthy children presenting for well-child visits were used as controls. Subjects were excluded if they were not toilet-trained, had an active UTI, urinary tract stones, spina bifida or congenital anomalies of the lower urinary tract. Patients/ parents were asked to complete the Dysfunctional Voiding Symptom Score (DVSS) and grade urine color on an 8-color urine color scale (Armstrong 1994; International Journal of Sports Nutrition, 4, 265-279) on the same clinic visit day. Urine specific gravity was captured on a urine analysis obtained within 3 months of completing the questionnaire. Correlation analysis was performed between urine color score, urine specific gravity and DVSS score.

The mean patient age was 9.5 + 3.9 years and the majority (60%, 30/50) were females. Patients with VD and normal controls were not significantly different regarding age (p = 0.554), BMI (p = 0.984) or gender distribution (p = 0.154). The median total DVSS for patients with VD was 10 (IQR= 6-13) and the median urine color score was 3 (IQR= 3-4).

Patients with VD had a significantly higher median total DVSS than controls [10 (IQR = 6-13) vs 6 (IQR = 4-7.5); p= 0.001). Among patients with VD, correlation analysis demonstrated a moderate positive correlation between the total DVSS and the urine color scale score (r = 0.426, p = 0.021). Nevertheless, there was no significant correlation between urine color scale score and urine specific gravity (r = 0.207, p = 0.166).

Despite the small sample size, our preliminary data indicate that the severity of VD symptoms positively correlates with the urine color scale that reflects the patient’s hydration status. Although subjective, it can be used to monitor patients’ adherence to adequate hydration which can improve their VD symptoms.