Find a Physician

Return to Center for Urodynamics and Incontinence Overview

Clinical Services

Return to Center for Urodynamics and Incontinence Overview

Health Information

Return to Center for Urodynamics and Incontinence Overview

Research and Clinical Trials

Return to Center for Urodynamics and Incontinence Overview

For Patients, Families & Visitors

Return to Center for Urodynamics and Incontinence Overview

Professionals

Return to Center for Urodynamics and Incontinence Overview

Hospital News

Return to Center for Urodynamics and Incontinence Overview

Urology

Center for Urodynamics and Incontinence

The Division of Pediatric Urology offers a state-of-the-art Center for Urodynamics and Incontinence at Morgan Stanley Children's Hospital to treat children with incontinence as well as other conditions that affect bladder function. In the two years since the Center's opening, our staff has treated more than 1,000 patients. Demand has risen so drastically that the Division has opened a second urodynamics laboratory. The Center is one of the few facilities available where children with incontinence can go for comprehensive testing and treatment, particularly for studies that can obtain X-ray images of the bladder, simultaneously recording bladder pressure measurements in what is called a video urodynamic examination. Patients suspected of having serious bladder problems, or known to have spina bifida, cerebral palsy or wetting problems in association with a condition called vesicoureteral reflux are more likely to have this evaluation. The Center treats approximately 150 children with spina bifida and prides itself on its proactive mission to prevent permanent bladder damage in these children and/or to avoid later procedures such as bladder augmentation or bladder neck surgery.

Our philosophy is to steer the child with incontinence to non-invasive investigations when possible, while at the same time aggressively treat the condition to prevent future bladder damage. The majority of our patients have wetting problems without a neurologic or serious anatomic cause. While this type of incontinence is a common condition in children, many are left untreated. However, minor causes for the wetting may lead to more severe consequences and should be evaluated by a pediatric urologist. It is important for the child's self-esteem and social interactions to have the condition evaluated as early as possible. Left untreated, the cause of incontinence may also lead to permanent damage of the bladder or even the kidneys. If nothing else, it can also lead to lifelong problems with frequency and urgency, the latter sometimes seen in women who had been untreated as children.

Agnes Bayer, RN, the Center's nurse practitioner, designed the urodynamics laboratory - a colorful, welcoming, and child-friendly space for children who are going through testing and treatment. Ms. Bayer plays a major role in the biofeedback program.

Andrew Combs, a physician assistant with 28 years experience with urodynamics and the treatment of pediatric voiding disorders, joined the staff as head of the Center in January 2007. "As you see children through the years," says Mr. Combs, "you develop a greater appreciation for the condition and the affect it has on the child and their family. We take pride in being one of the few places in the New York area that can offer the full range of urodynamic testing, assessing what is wrong, and finding a solution. Finding a solution depends on precisely identifying the source of the problem."

Many parents and even some pediatricians are surprised to hear the root of the problem is physical and not psychological. Identifying the physical source takes time, since children with nearly identical symptoms may have completely different underlying disorders, each with its own therapeutic regimen. The most common problem among these children is the tendency to squeeze their pelvic floor muscles during urination when they should be relaxing them. The bladder muscles contract normally to expel urine. When the pelvic floor muscles tighten up at the same time, it becomes difficult for the bladder to empty. Some children are actually playing a tug-of-war with the bladder and the pelvic floor muscles. The result is a bladder that does not empty, resulting in an increase in the bladder pressure, and then another urgent trip to the bathroom. Using a variety of biofeedback techniques including computerized games, Mr. Combs and Ms. Bayer teach children how to control and coordinate their muscles during urination. In as few as three one-hour biofeedback sessions, the problem of uncoordinated voiding can be corrected. It is very satisfying to see children leave the Center dry with newly restored self-esteem.

The Center for Urodynamics and Incontinence is internationally recognized, training clinicians to develop units at other institutions. Our physicians, physician assistant and nurse practitioner often contribute to the literature, present at national conferences and participate on international committees devoted to the treatment of children with voiding dysfunction and incontinence.