We report a 3-year-old girl with dysfunctional voiding, febrile urinary tract infection (UTI) and bladder over distention (BOD). After controlling UTI, repeat uroflowmetry depicted staccato flow pattern and postvoid residual (PVR) urine volume was >20 mL. Frequency/volume chart showed voided volume was frequently larger than >100% expected bladder capacity. BOD resulted in dysfunctional voiding and elevated PVR was impressed. Urotherapy with adequate fluids intake, and timed voiding to avoid BOD were taught. Subsequent frequency/volume chart disclosed that voided volume was not greater than 100% expected bladder capacity. Uroflowmetry curves were normalized and PVR decreased. Without prophylactic antibiotics, she was free of UTI for 12 months. Unfortunately, she held urine after attending kindergarten and got febrile UTI again. BOD was impressed and timed voiding was re-initiated after resolution of UTI. She was free of UTI and antibiotics for another 15 months. Bladder over distension may be the cause of dysfunctional voiding, vesicoureteral reflux and UTI. Through timed voiding, BOD may be reversed and UTI may be prevented.
Keywords: bladder over distention; children; dysfunctional voiding; urinary tract infection.
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