New ideas in the cause of bladder dysfunction in children.

PURPOSE OF REVIEW

The management of children with urinary incontinence and dysfunctional voiding problems can be very difficult at times. The present array of bladder-oriented treatments are marginally successful and for a long time patients were told that they would outgrow their symptoms. In this review, we look at the most recent findings in the urologic and psychiatric literature and try to piece together these two disparate fields and figure out how children who wet are best managed.

RECENT FINDINGS

It became clear that children with attention deficit disorder were always more difficult to manage than those without neuropsychiatric problems. As the years have progressed and imaging technology has improved, we have begun to look into the active brain. This research has been conducted primarily in the fields of psychiatry and neuroscience, but there have been some seminal studies that point to a link between defects in the brain and functional urinary problems in children. In this review, we will attempt to outline the reasons why the traditional bowel program works and why there are such a large number of patients with neuropsychiatric problems who have functional urinary problems as children.

SUMMARY

Utilizing an approach that focuses on a treatment paradigm that is neurocentric instead of vesicocentric allows us to treat children who do not respond to the usual treatments and target the brain with centrally active medications such as tricyclics and serotonin reuptake inhibitors. Understanding that it is a problem in the central nervous system, and that in some cases it is necessary to treat the underlying neuropsychiatric problems to be able to get these children to remain dry is a very important step in the management of children with refractory wetting problems.