THE DYSFUNCTIONAL VOIDING SCORING SYSTEM : OBJECTIVE CRITERIA FOR EVALUATION OF VOIDING DYSFUNCTION IN CHILDREN

Purpose: The impact of acquired voiding dysfunction (DV) on the social and urologic health of the individual child is well recognized. However, due, principally to the lack of available measurement instruments to describe DV, the literature is devoid of studies which provide objective, meaningful assessment of diagnosis or treatment response, either within or across various DV populations. This study evaluates the performance of a newly devised objective instrument to quantify pediatric DV symptoms in a children's hospital. The Dysfunctional Voiding Scoring System (DVSS) is a child-specific modification of the American Urological Association Scoring System for BPH (IPSS). Materials and Methods: Ten voiding dysfunction parameters were assigned scores of 0 to 3 according to prevalence: 'not-at-all'=0, 'less than half the time'=1, 'half the time'=2, 'almost always'=3. One of the 10 parameters included assessment of specific child-life stresses ('absent' =0, 'present' =3). The total score ranged from 0 to 30. Unlike the BPH/IPSS scoring system, the urology nurse administered the DVSS with responses obtained from parent and/or child. Consecutive patients (aged 3 to 10 years) presenting to the Pediatric Urology Clinic, with a history of diurnal urinary incontinence, urinary tract infections, or vesicoureteral reflux, were evaluated with the DVSS. A second aged matched group consisted of children without suspected voiding dysfunction from the non-diabetic endocrine clinic. Results: 35 patients with clinically suspected voiding dysfunction were evaluated with the DVSS. Female: male ratio was 16:1. Scores were elevated ([is greater than]10) in 32 of 35 children. Mean symptom score in the group with suspected voiding dysfunction was 15.4/ 30. In the subjects without suspected voiding dysfunction (n = 14), female to male ratio was 2:1, scores were [is less than or equal to] 10 in 13 of 14, and mean symptom score was 3.5/30. Using a score of [is greater than] 10 to define potentially significant voiding dysfunction, the DVSS shows a sensitivity of 97%, specificity of 76%, positive predictive value 88%, and negative predictive value 93% (Chi-square). The individual scores in both groups are depicted. The means were significantly different (p [is less than] 0.00001, Student's t-test). Conclusion: The DVSS instrument appears to provide an accurate and objective (i.e., numerical) description of voiding behaviors in children. Furthermore, it appears able to accurately pred