Clinical Evaluation: History Taking and Urological, Gynaecological and Neurological Evaluation

  • Cevdet Kaya
  • Christian RadmayrEmail author
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)


Most children referred for urodynamic studies already have specific pathological diagnoses such as spinal dysraphism, spinal cord injury or cerebral palsy as well as voiding dysfunction. When paediatric urologists need to evaluate a child, an understanding of the main complaints, a detailed medical history as well as a focused physical examination are essential for setting up an appropriate management strategy for these patients. The comprehensive history should reflect the general health status in addition to a specific voiding and defecation history. Frequency-volume charts, voiding diaries, and symptom scores will be helpful for a sufficient workup. Physical examination should cover the inspection and palpation of the abdomen, genitalia and with special attention the back of the child. While urological examination focuses on external genitalia, neurological examination includes the assessment of perineal sensation, the perineal reflexes from the sacral segments and anal sphincter tone and control. Asymmetry of the buttocks, legs or feet and other signs of occult spinal dysraphism in the lumbosacral area have to be investigated carefully. Gynaecological examination can provide important information on external genitalia as well as the introitus, the urethral meatus and the perineum.


Urologic dysfunction Evaluation Spinal dysraphism Urinary tract Lower urinary tract symptoms Bladder Voiding diary Spinal cord injury Incontinence Constipation 


  1. 1.
    Hinman F, Baumann FW. Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol. 1973;109:727.CrossRefPubMedGoogle Scholar
  2. 2.
    Piatt JH Jr. Treatment of myelomeningocele: a review of outcomes and continuing neurosurgical considerations among adults. A review. J Neurosurg Pediatr. 2010;6:515–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Abrahamsson K, Olsson I, Sillen U. Urodynamic findings in children with myelomeningocele after untethering of the spinal cord. J Urol. 2007;177:331–4.CrossRefPubMedGoogle Scholar
  4. 4.
    Kaplan KM, Spivak JM, Bendo JA. Embryology of the spine and associated congenital abnormalities. Spine J. 2005;5:564–76.CrossRefPubMedGoogle Scholar
  5. 5.
    Sutherland RS, Mevorach RA, Baskin LS, Kogan BA. Spinal dysraphism in children: an overview and an approach to prevent complications. Urology. 1995;46:294–304.CrossRefPubMedGoogle Scholar
  6. 6.
    Ackerman LL, Menezes AH. Spinal congenital dermal sinuses: a 30-year experience. Pediatrics. 2003;112:641–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Assaad A, Mansy A, Kotb M, Hafez M. Spinal dysraphism: experience with 250 cases operated upon. Child Nerv Syst. 1989;5:324–9.CrossRefGoogle Scholar
  8. 8.
    Guggisberg D, Hadj-Rabia S, Viney C, Bodemer C, Brunelle F, Zerah M, et al. Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol. 2004;140:1109–15.CrossRefPubMedGoogle Scholar
  9. 9.
    Tamaki N, Shirataki K, Kojima N, Shouse Y, Matsumoto S. Tethered cord syndrome of delayed onset following repair of myelomeningocele. J Neurosurg. 1988;69:393–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Tarcan T, Bauer S, Olmedo E, Khoshbin S, Kelly M, Darbey M. Long-term followup of newborns with myelodysplasia and normal urodynamic findings: is followup necessary? J Urol. 2001;165:564–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Macejko AM, Cheng EY, Yerkes EB, Meyer T, Bowman RM, Kaplan WE. Clinical urological outcomes following primary tethered cord release in children younger than 3 years. J Urol. 2007;178:1738–43.CrossRefPubMedGoogle Scholar
  12. 12.
    Maher CO, Bauer SB, Goumnerova L, Proctor MR, Madsen JR, Scott RM. Urological outcome following multiple repeat spinal cord untethering operations. J Neurosurg Pediatr. 2009;4:275–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Kaplan WE. Urodynamics of upper and lower urinary tract. In: Docimo SG, editor. Kelalis-King-Belman textbook of clinical pediatric urology. London: Informa healthcare; 2007. p. 747–64.Google Scholar
  14. 14.
    Sillén U, Hellström AL. Pragmatic approach to the evaluation and management of non-neuropathic daytime voiding disorders. In: Gearhart JP, Rink RC, Mouriquand PDE, editors. Pediatric urology. Philadelphia: Saunders Elsevier; 2010. p. 366–79.CrossRefGoogle Scholar
  15. 15.
    Wilcox DT. The urinary tract in anorectal malformations, multisystem disorders and syndromes. In: Thomas DFM, Duffy PG, Rickwood AMK, editors. Essentials of pediatric urology. London: Informa healthcare; 2008. p. 189–98.CrossRefGoogle Scholar
  16. 16.
    Canning DA, Lambert SM. Evaluation of the pediatric urology patient. In: Wein AJ, editor. Campbell-Walsh urology. Philadelphia: Elsevier Saunders; 2012. p. 3067–84.CrossRefGoogle Scholar
  17. 17.
    Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P. International Children’s continence society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn. 2015;34:640–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Farhat W, Bägli DJ, Capolicchio G, O’Reilly S, Merguerian PA, Khoury A, McLorie GA. The dysfunctional voiding scoring system: quantitative standardization of dysfunctional voiding symptoms in children. J Urol. 2000;164:1011–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Greydanus DE, Torres AD, O’Donnel DM, Feinberg AN. Enuresis: current concepts. Indian J Pediatr. 1999;66:425–38.CrossRefPubMedGoogle Scholar
  20. 20.
    Agarwal SK, Bagli DJ. Neurogenic bladder. Indian J Pediatr. 1997;64:313–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992;33(6):818–24.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Combs AJ, Van Batavia JP, Chan J, Glassberg KI. Dysfunctional elimination syndromes: how closely linked are constipation and encopresis with specific lower urinary tract conditions? J Urol. 2013;190(3):1015–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Roth EB, Austin PF. Evaluation and treatment of Nonmonosymptomatic enuresis. Pediatr Rev. 2014;35(10):430–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Kaplan WE, McClone DG, Richards I. The urological manifestations of the tethered spinal cord. J Urol. 1988;140:1285–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Kumar R, Singhal N, Gupta M, Kapoor R, Mahapatra AK. Evaluation of clinic-urodynamic outcome of bladder dysfunction after surgery in children with spinal dysraphism. Acta Neurochir. 2008;150:129–37.CrossRefPubMedGoogle Scholar
  26. 26.
    Ku JH. The management of of neurogenic bladder and quality of life in spinal cord injury. BJU Int. 2006;98(4):739–45.CrossRefPubMedGoogle Scholar
  27. 27.
    Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18(2):255–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Moslavac S, Dzidic I, Kejla Z. Neurogenic detrusor overactivity: comparison between complete and incomplete spinal cord injury patients. Neurourol Urodyn. 2008;27(6):504–6.CrossRefPubMedGoogle Scholar
  29. 29.
    Feldman AS, Bauer S. Diagnosis and management of dysfunctional voiding. Cur Opin Pediatr. 2006;18:139–47.CrossRefGoogle Scholar
  30. 30.
    Bauer SB. Special considerations of the overactive bladder in children. Urology. 2002;60(suppl 5A):43–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Schulman SL. Voiding dysfunction in children. Urol Clin N Am. 2004;31:481–90.CrossRefGoogle Scholar
  32. 32.
    Keating MA, Rink R, Bauer SB, et al. Neuro-urologic implications in changing approach in management of occult spinal lesions. J Urol. 1988;140:1299.CrossRefPubMedGoogle Scholar
  33. 33.
    Anderson FM. Occult spinal dysraphism. Pediatrics. 1975;55:826–35.PubMedGoogle Scholar
  34. 34.
    Kang H, Wang K, Kim SK, Cho BK. Prognostic factors affecting urologic outcome after untethering surgery for lumbosacral lipoma. Childs Nerv Syst. 2006;22:1111–21.CrossRefPubMedGoogle Scholar
  35. 35.
    Amarante MA, Shrensel JA, Tomei KL, Carmel PW, Gandhi CD. Management of urological dysfunction in pediatric patients with spinal dysraphism: review of the literature. Neurosurg Focus. 2012;33(4):1–9.CrossRefGoogle Scholar
  36. 36.
    Marshall DF, Boston VE. Does the absence of anal reflexes guarantee a safe bladder in children with spina bifida? Eur J Paediatr Surg. 2001;11(Suppl I):S21–3.CrossRefGoogle Scholar
  37. 37.
    Sakakibara R, Hattori T, Uchiyama T, Kamura K, Yamanishi T. Uroneurological assessment of spina bifida cystic and occulta. Neurourol Urodyn. 2003;22:328–34.CrossRefPubMedGoogle Scholar
  38. 38.
    Neveus T, Eggert P, Evans J, International Children’s Continence Society, et al. Evaluation of and treatment for monosymptomatic enuresis: a standardization document from the international Children’s continence society. J Urol. 2010;183(2):441–7.CrossRefPubMedGoogle Scholar
  39. 39.
    Redman JF. Conservative management of urethral prolapse in female children. Urology. 1982;19(5):505–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Powell DM, Newman KD, Randolph J. A proposed classification of vaginal anomalies and their surgical correction. J Pediatr Surg. 1995;30(2):271–275; discussion 275–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Soyer T, Aydemir E, Atmaca E. Paraurethral cysts in female newborns: role of maternal estrogens. J Pediatr Adolesc Gynecol. 2007;20(4):249–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Peña A. Anorectal malformations. Semin Pediatr Surg. 1995;4:35–47.PubMedGoogle Scholar
  43. 43.
    Peña A, Levitt MA. Anorectal malformations: experience with the posterior sagittal approach. In: Stringer MD, Oldham KT, Mouriquand PDE, editors. Pediatric surgery and urology: long-term outcomes. 2nd ed. Cambridge: Cambridge University Press; 2006. p. 401–15.CrossRefGoogle Scholar
  44. 44.
    Silva JA, Alvares RA, Barboza AL, Monteiro RT. Lower urinary tract dysfunction in children with cerebral palsy. Neurourol Urodyn. 2009;28(8):959–63.CrossRefPubMedGoogle Scholar
  45. 45.
    Richardson I, Palmer LS. Clinical and urodynamic spectrum of bladder function in cerebral palsy. J Urol. 2009;182(4 Suppl):1945–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Urology, School of MedicineMarmara UniversityIstanbulTurkey
  2. 2.Department of Urology, School of MedicineInnsbruck UniversityInnsbruckAustria

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