**3. Evaluation of a child with dysfunctional voiding**

Evaluation of children with DV includes taking anamnestic data, physical examination, filling in the bladder and bowel diary, urinalyses and urine culture, ultrasound examination of the bladder and kidneys and uroflowmetry with determination of post-void residual urine. Cystometry, voiding cystourethrography and MRI of the spine are indicated only in certain cases.

#### **3.1 History**

The evaluation process begins with anamnesis, data on perinatal factors, developmental course, current mental state, school success and events during toilet training. Every child should be asked how he urinates, whether he has difficulty starting to urinate, whether urinating is difficult and whether he strains when urinating. Also, one should insist on the characteristics of the urinary stream, such as strength and continuity. A weak and intermittent stream indicates the existence of DV. The child should be asked if he has a feeling of incomplete urination or urinary retention (inability to urinate). Questions regarding urgency, voiding frequency and severity of daytime and nighttime wetting, pelvic holding maneuvers, and bowel emptying should follow.

#### **3.2 Physical examination**

#### *3.2.1 Abdominal examination*

Palpation of the left iliac fossa is necessary in order to determine fecal impaction. Suprapubic tenderness may indicate the presence of cystitis. If urine leaks when the bladder is pressed, the existence of a neurogenic bladder with sphincter damage should be suspected.
