We studied the efficacy, functional outcome and morphological changes following extracorporeal shock wave lithotripsy (ESWL*) of renal calculi in a pediatric population. We prospectively evaluated 50 patients 2 to 12 years old (mean age 7.64) undergoing ESWL with the Siemens Lithostar Plus. Functional outcome was assessed by comparing total and ipsilateral glomerular filtration rates before and after ESWL. Glomerular filtration rate was measured using Gates' method on a 99mtechnetium-pentetic acid radionuclide renal scan corrected to body surface area times 1.73 m.2. Ultrasound was performed to assess morphological changes after ESWL. The immediate fragmentation rate was 86% and the clearance rate was 82%. At the end of the study 40 patients were evaluable. Immediately after ESWL ultrasonography showed perirenal hematoma in 3 patients, intrarenal hematoma in 2 and subcapsular hematoma in 1. These changes resolved spontaneously at followup. There was no change in total or ipsilateral glomerular filtration rate at a mean followup of 31.7 months. Before and after ESWL total glomerular filtration rates were 86.58 +/- 12.43 and 86.27 +/- 12.82 ml. per minute per 1.73 m.2, respectively. Treated kidney glomerular filtration rate decreased insignificantly from 40.58 +/- 12.61 to 40.41 +/- 12.61 ml. per minute per 1.73 m.2 at 3 months. At the last followup the change in glomerular filtration rate was insignificant. ESWL is effective in the pediatric population, and it can be safely performed without long-term bio-effects on the function or morphology of the growing kidney.

Dysfunctional voiding (DV) is a voiding disorder characterized by dyssynergic striated sphincteric activity in the absence of a proven neurological etiology. It can present at any age with a spectrum of storage and voiding symptoms that may resemble florid neurogenic bladder. There is a striking lack of clarity regarding what this entity represents, the diagnostic methodology and treatment. The limitations of existing guideline documents are analyzed. Specifically, use of the term "habitual", the assumption that bladder changes are secondary to the outlet, the emphasis on "staccato" voiding and the implication of striated urethral sphincter are discussed. Literature shows that DV may also present with continuous slow flow or normal flow. Dyssynergia may be at the level of the striated urethral sphincter, the pelvic floor or both, better termed "striated urethral sphincter-pelvic floor complex" (SUS-PFC).A diagnostic algorithm is provided so that patients are evaluated on merit rather than on the basis of different philosophies of individual centers. High-risk markers such as hydronephrosis, vesicoureteral reflux, renal failure or marked voiding difficulty should prompt a formal urodynamics evaluation and imaging for neurological etiology. Patients with predominantly storage symptoms with incidental staccato voiding can be managed initially, on the basis of non-invasive evaluation. Conservative urotherapy including biofeedback is appropriate initial management for patients without high risk factors. Treatment and evaluation should be escalated based on response. Patients with severe DV will need treatment similar to neurogenic bladder including clean intermittent catheterization and measures to control storage pressures.

Aims: The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure‐flow studies of 1997.Methods: Based on the ICS standard for developing evidence‐based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release.Results: The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure‐flow study (PFS) for patients in part 1. A pressure‐flow plot is recommended for the diagnosis of every patient, in addition to time‐based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure‐flow scatter graph including every patient's p_det at maximum flow (p_detQmax) with maximum flow rate (Q_max) point should be included in all scientific reports considering voiding dysfunction.Conclusion: PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

Aims: The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies.Methods: Based on the ICS standard for developing evidence‐based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release.Results: The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient.Conclusion: A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.