Bladder-sphincter dysfunction in childhood.

While it is obvious that the combination of elevated intravesical pressure, urinary tract infection, and reflux can be devastating to the upper urinary tracts, it has been appreciated only recently that a single mechanism, obstruction due to disorders of vesicourethral function, can produce all three pathologic phenomena in neurologically normal children. Advances in pediatric urodynamics now permit these patients to be recognized and their particular pattern of bladder and sphincter dysfunction to be diagnosed with certainty. Individualized therapy aimed at the underlying functional disturbance is often successful and may make surgical therapy unnecessary.