Functional lower urinary tract disorders in children with urinary tract infection and vesicoureteral refluxFunctional lower urinary tract disorders in children with urinary tract infection and vesicoureteral reflux

Functional lower urinary tract disorders are common in toilet-trained children with urinary tract infection (UTI) and may contribute to secondary vesicoureteral reflux (VUR). This arti-cle reviews three overlapping presentations: constipation-associated bladder and bowel dysfunction, overactive bladder, and dysfunctional voiding. It outlines an assessment that can be completed at the first outpatient visit: a bladder diary kept for at least 2 days and 3 nights, uroflowmetry with postvoid residual measurement and, where available, pelvic floor elec-tromyography, together with bladder and rectal ultrasonography. An exploratory analysis of 27 children with a documented history of febrile UTI enrolled in a prospective study of non-neurogenic overactive bladder is presented. Detrusor overactivity, reduced maximum cysto-metric capacity, or both were present in 24 of 25 children with baseline urodynamic data. Children with recurrent febrile UTI more often had detrusor overactivity (13/13 versus 6/12; p = 0.005) and higher maximal detrusor pressure (median 32 versus 17 cmH₂O; p = 0.006) than those with a single episode. These findings are hypothesis-generating and were obtained wit-hout a UTI-free comparator. Assessment of storage function, bladder emptying, and bowel routine supports a rational approach to pharmacotherapy and urotherapy.