2 The article by Hoebeke and colleagues reviews methods

for assessment of children with Romidepsin in vitro daytime urinary incontinence using evidence from the literature and assembling it in this standardized document.1 The article emphasizes the importance of taking an accurate medical history and questioning the child when possible. They suggest that, although experienced practitioners treating children with lower urinary tract dysfunction can usually diagnose their problems, others may prefer to use scoring systems such as that by Akbal and colleagues.3 A voiding diary of fluid intake and output during a 24-hour period as well as keeping track of urinary frequency and voided volumes can be useful. A similar chart should Inhibitors,research,lifescience,medical be kept for bowel habits. The physical examination should determine if bladder distension or fecal impaction Inhibitors,research,lifescience,medical is present. Also, neurologic testing will assess the integrity of sacral segments. Noninvasive testing includes a renal/bladder ultrasound and uroflow studies. The authors indicate that residual urine > 10% of the expected bladder capacity for age (in cc) is significant. The ultrasound also provides information on the presence of constipation. A bladder Inhibitors,research,lifescience,medical base impression and rectal width > 3 cm in the absence of an urge to have a bowel movement is a significant indicator of constipation. When there is significant

urinary frequency and irritative symptoms, a urinalysis is recommended not only to assess for Inhibitors,research,lifescience,medical urinary tract infection (UTI) but also for pH and calcium content because the group from Vanderbilt has reported hypercalciuria in a subgroup of dysfunctional voiding syndromes in childhood.4 The uroflowmetry measures the urinary stream during voiding and quantifies the volume voided over a unit of time.1 The

Inhibitors,research,lifescience,medical Qmax refers to the peak or maximal flow rate in milliliters per second and the Qave reflects average flow per unit of time. Generally, Qave is usually > 50% but < 85% of the Qmax value. The uroflow curve is normally bell shaped in all healthy children, but will change when the voided volume is < 50% of the expected bladder capacity for age. The authors note that the uroflow studies may help identify those who need video-urodynamic studies. The authors propose that patients with thick-walled Calpain bladders on ultrasound and obstructed flow patterns and dilated lower ureters may have reflux or poor compliance. These patients, in addition to those who have failed all conventional therapy, should undergo video-urodynamic studies. They stress in their article that the voiding cystourethrogram should not be part of the routine assessment of most children with urinary incontinence. Forthcoming reports from the ICCS will discuss effective treatments for daytime incontinence. The second article by Nevéus and colleagues discusses recommendations for treating children with monosymptomatic nocturnal enuresis (MNE).