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Are idiopathic detrusor overactivity disorder/overactive bladder and dysfunctional voiding one entity? Or in other words do children migrate from one condition to the other?
Kenneth I. Glassberg, MD, Jason P. Van Batavia, MD, Andrew J. Combs, RPA-C.
Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian Hospital,, New York, NY, USA.
BACKGROUND: We wanted to determine if children with dysfunctional voiding (DV) and idiopathic detrusor overactivity (IDO) convert back and forth between both conditions. IDOD (idiopathic detrusor overactivity disorder) is generally referred to by the symptom syndrome of OAB. IDOD requires a short EMG lag time on uroflowmetry with simultaneous EMG (uroflow/EMG) to confirm the presence of IDO and also requires a quiet pelvic floor EMG while voiding. No such requirements are necessary when using the term OAB. Essentially, IDOD is OAB with stiffer diagnostic requirements.
METHODS: We identified 77 children diagnosed with DV on uroflow/EMG. All DV patients had an active pelvic floor EMG on voiding and all had at least one confirmatory study. We also identified another, separate cohort of 77 children with IDOD (ie, EMG lag time <2 sec). All of these children with IDOD had a quiet pelvic floor EMG on voiding. All children from both cohorts had at least one follow-up uroflow/EMG. All patients with DV were treated with biofeedback +/- anticholinergics. All patients with IDOD were treated with anticholinergics. Bowel dysfunction was addressed when present and in addition, all children received standard therapy.
RESULTS: In 70 of 77 (91%) children with DV, the follow-up EMG was quiet during voiding. Thirty-one of the 70 children were treated with biofeedback but no anticholinergics; 25 of these 31 (81%) converted to a quiet EMG but with a short EMG lag time (11 with EMG lag time <2sec; 14 with lag time < 0sec). Of the 37 children initially treated with anticholinergics in addition to biofeedback, 8 (21%) had a short lag time on follow-up uroflow/EMG studies. Of the 77 patients with IDOD and an initial quiet EMG, only 2 (3%) showed any EMG activity during voiding on follow-up flow studies and none went on to require biofeedback therapy.
CONCLUSIONS: DV and IDOD are 2 distinct primary conditions in children and do not appear to migrate back and forth even though their associated symptoms are often quite similar. An active external sphincter during voiding is the driving force in DV while IDO is the driving force in IDOD. DV is known to be associated with secondary DO in the vast majority of cases and some patients with DV, after successful biofeedback, can convert to findings suggestive of IDOD on follow up uroflow/EMG (ie short lag time). This conversion only represents unmasking of the short lag time that has been camouflaged by the active EMG of dysfunctional voiding rather than a conversion to IDOD and most often occurs in those who had not been placed on anticholinergics in conjunction with their biofeedback. Those with IDOD, likely do not convert to DV, at least if their IDO is adequately treated.
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