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Bladder Control

The nurses and physicians at Pediatric Urology Associates have a tremendous amount of experience in dealing with all pediatric bladder control issues. Our physicians have lectured in national meetings and authored many papers on these topics. Pediatric Urology Associates is also involved with ongoing new treatments for children who have been refractory to standard treatment. 

ENURESIS 
Bed-wetting, or enuresis, is a common condition in young children. Approximately 15% of all five-year-old children will wet the bed at night. Generally, enuresis is not the sign of an alarming problem with the kidneys or bladder. We individualize the treatment of each child's bed-wetting to their individual situation. We manage enuresis with as little testing and as few invasive procedures as necessary. 

Bed-wetting can result from a variety of causes. Some children will have bed-wetting because of a lack of a certain hormone production that tells the kidneys to produce less urine overnight. Other children will wet the bed because of bladder spasms or a small capacity bladder. Some children will need medication to help them improve. Others will require behavior modification and some need both. Regardless which approach is taken, ultimately our success rates of improving the child's bed-wetting are quite good. 

FREQUENT URINATION 
Children come to Pediatric Urology Associates quite often with the complaint of frequent urination. We begin a thorough evaluation to rule out the possibilities of urinary tract infection, bladder abnormalities and inability to empty the bladder completely. These children often also have issues with constipation which can affect the normal function of the bladder. Once our evaluation is completed we can individualize treatment for the child depending on our findings. 
There are some children who require biofeedback training. We liken this to a tennis coach or piano teacher who will help them master their bladder at night coordination so they can empty regularly and effectively. 

URINARY INCONTINENCE 
Urinary incontinence, or wetting, is something that can be upsetting and embarrassing for children. It is our goal to make the children as dry as possible as quickly as possible. 

Our evaluation of the incontinent child starts with urinalysis and urine culture to make sure that there are no problems such as urinary tract infection or too much protein or sugar in the urine. We will often get a ultrasound to make certain that the bladder is emptying completely and totally and and that there were no other problems related to the bladder. We will also assess the child's bowel habits as bowel problems (such as constipation) can impact normal bladder function. Some children may require non-invasive testing such as a uroflow and EMG. These are painless tests that measures the velocity of the voided urine, and the ability of the bladder and the sphincter to work in cooperation. With the results of these tests we may determine that a child needs either biofeedback to help train their muscles for proper bladder emptying or they may need short-term medication. It is uncommon that we need to do invasive testing or procedures for children with incontinence. 

NEUROGENIC BLADDER 
Pediatric Urology Associates has extensive experience helping children who have bladder control issues due to neurological disorders such as spina bifida or spinal cord injury. These are special situations that require intensive consultation with the family and child. Our goals are to have the children be dry and to preserve the function of the kidneys. We also want the children to be able to have regular bowel movements and to achieve overall independence.

One of the tests that are helpful to achieve these goals is the urodynamics test. Urodynamics testing tells us much about the function of the bladder including its size, its pressure and whether or not the bladder is emptying completely.

A variety of treatment approaches are available and are tailored to the individual needs of each child. Some of these treatments include medication, clean intermittent catheterization, bowel elimination programs, Botox injections, bladder reconstructive surgery and MACE procedures. Knowing which child needs which treatment is a special expertise of the doctors and nurses at Pediatric Urology Associates.