Functional disorders of the urinary system in children

Functional disorders of the urinary system are found in children with a frequency of 10% in the general population. Among patients at nephrourological hospitals, functional disorders, such as those weighing the main diagnosis, or as an independent disease, are diagnosed in 50% of children and more.

A healthy child should let know about his desire to empty the bladder already in the second half of life. A natural motivation for this is the unpleasant sensation of wet diapers. The wide distribution of diapers that facilitate the care of the child led to a delay in the formation of a negative conditioned reflex to wet diapers, a delay in the formation of the mixing function.

The criteria for the first stage of maturity, reached in the norm to 3-4 years, are as follows:

• the correspondence of the functional volume of the bladder to the age of the child (average 100-125 ml);
• adequate diuresis and volume of each exercise the number of urination per day (no more than and no less than 7-9 times);
• complete retention of urine day and night;
• the ability to delay for a while and interrupt if necessary an act of urination;
• the ability to empty the bladder without a previous urge to urinate and with a small amount of urine due to volitional management of the sphincter mechanism.

If the children are older than 4 years of persistent pollakiuria, imperative urges, mandatory urinary incontinence, nocturnal enuresis, then this indicates that the process of becoming the main features of the mature type of urination has not come to an end. After "control age" (4 years), abnormalities in the nature of urination should be considered as a disease.

The second stage lasts from 4 to 12-14 years. There is a gradual increase in the reservoir function of the bladder, a decrease in the tonus of detrusor and intravesical pressure. In the pubertal period (12-14 years), sexual hormones, potentiating effects of the sympathetic department of the autonomic nervous system, are included in the regulation of the basic functions of the bladder.

The most common cause of delayed maturation and (or) disturbance of the mechanisms of urinary excretion in children is the consequences of birth trauma with persisting minimal brain dysfunction; hypoxia of the fetus and conditions associated with the development of hypoxia in the postnatal period (frequent ARI, pneumonia, sinusitis, nasal breathing disorders).

Depending on the volume of the bladder, when urination sets in, three variants are distinguished. The urinary bladder is considered to be normoreflectory if urination occurs at a normal age range of the bladder, hyporeflective - at a volume exceeding the upper limit of the norm, hyperreflective - at a volume less than the lower limit of the norm. Causes of changes in the nature of urination may be congenital dysplasia of connective tissue, spine lesions, neurotic disorders, neurogenic dysfunctions. The most common form of neurogenic dysfunction is the hyperreflex urinary bladder, it occurs when the conduction of the nerve pathways of the spinal cord is above the sacral segments at the level of the 9th thoracic vertebra. A rare option is a hyporeflective urinary bladder. There is a weakening urge to urinate, rare rations in large portions, a large amount of residual urine. It is observed when the posterior root of the sacral region of the spinal cord, the cauda equina and the pelvic nerve are affected.

In the examination of children with neurogenic bladder dysfunction, in addition to a nephrourologist, a pediatrician, a neurologist, and an orthopedist are involved.

[1], [2], [3], [4], [5], [6], [7], [8], [9]