She was evaluated in June 2020 by Fernando Ferrer, MD, FACS, FAAP, and Erin Miller, MSN, NP. The patient had had at least 10 febrile UTIs in her lifetime, typically without symptoms of daytime wetting, holding, or frequency. Nighttime bedwetting and constipation, for which AV had taken a laxative, was reported by her mother.
A thorough diagnostic evaluation included: a voiding cystourethrogram (VCUG) previously performed in 2018; a renal bladder ultrasound (RBUS) with postvoid residual urine volume (PVR) and rectal diameter; a kidney, ureter, and bladder (KUB) x-ray; completion of a voiding diary; a dysfunctional voiding scoring system (DVSS) questionnaire; and Bristol stool scale scoring. The DVSS score was found to be 19, which is quite high, and strongly correlates with a diagnosis of voiding dysfunction. Additionally, her Bristol stool scale score was type 1-2, and her KUB and RBUS/rectal diameter suggested a significant stool burden. Her VCUG was negative, and her kidneys were found to be normal in the RBUS.
Ultimately, the treatment included a bowel cleanout, continued treatment of chronic constipation, timed voiding, increased water and fiber intake, and treatment of UTI followed by continued low dose antibiotic prophylaxis. The plan going forward is to have AV, when she is agreeable, complete an Uroflow/EMG to assess her voiding flow pattern and sphincter activity. These results will provide guidance in determining further treatment, including biofeedback training. Recently, AV has been happier and feeling much better, and the team is delighted to see the progress she has made in such a short time.
Fernando Ferrer, MD, FACS, FAAP
COO, Mount Sinai Kravis Children's Hospital; Vice Chair, Hospital Operations, Pediatrics; Network Medical Director, Pediatric Services; Senior Faculty
Jeffrey A. Stock, MD, FACS, FAAP
Chief, Division of Pediatric Urology, and Associate Clinical Professor of Urology, and Pediatrics
Neha Malhotra, MD
Assistant Professor of Urology, Icahn School of Medicine at Mount Sinai
Erin Miller, RN, MSN, CPNP-PC
Department of Urology, Icahn School of Medicine at Mount Sinai