Refractory Voiding Dysfunction Program

Even after visiting the Children’s Continence Program at Riley at IU Health, a small number of children may still have issues with incontinence, recurrent infection and inability to empty their bladders. When this happens, they are referred to our Refractory Voiding Dysfunction Program.

The goal of the program is to give children part of their lives back. Children who are referred to this program are usually age 6 and up who have been dealing with incontinence (or other urinary problems) for years. They may have difficulty emptying their bladder, knowing when they need to go to the bathroom or have recurring urinary tract infections. Their quality of life has been impacted because they are worried about having accidents at school, and are concerned about relationships with peers or participating in sports and other activities.

Once your child is referred to the program, we review all bladder history and previous treatments to see if any treatment options or medications should be repeated. We will make sure all possible therapies have been tried and may order some advanced tests such as urodynamics or magnetic resonance imaging (MRI). Finally, we may consider a referral or consultation with other types of doctors, including neurosurgeons or gastroenterologists. If all forms of therapy, medications, behavioral modifications and other treatments have been exhausted, we consider other options.

Treatment Options for Voiding Dysfunction

The Refractory Voiding Dysfunction Program provides new and advanced treatment options, bringing hope to children and families who have been dealing with incontinence for years.

Some children benefit from sacral neuromodulation (Interstim^®), a technique previously used only for adults. For this procedure, small electrodes are placed near the sacral nerves that help control the bladder. The electrodes act like a pacemaker for the bladder, helping children know when they need to use the bathroom and assisting them with emptying their bladders. This procedure is performed in the operating room while your child is sedated. It involves a test period of about two weeks to see if the electrodes work. If so, a more permanent device is placed. This procedure has been beneficial in over 75 percent of patients who have failed all other therapies for reducing or curing incontinence.

Another treatment option for improving continence in some patients may be Botox^®. This treatment involves injecting Botox^® into the bladder muscle through a small scope. This procedure is done in the operating room. Botox^® helps relax the bladder and reduce incontinence. The effects usually last six to 12 months, and injections may need to be repeated.