Introduction: According to the International Children's Continence Society (ICCS), dysfunctional voiding is defined as the inability to adequately relax the external urethral sphincter and pelvic floor muscles in neurologically intact patients, resulting in intermittent urination and residual urine. Since the condition is associated with impaired bladder emptying, evaluation of pelvic organ anatomy and pelvic floor function is essential for early differential diagnosis and timely treatment. However, many clinics lack access to expensive diagnostic equipment, creating the need for accessible and easily performed methods. Transperineal ultrasound has demonstrated diagnostic value in adults with voiding dysfunction and may represent a practical alternative for pediatric patients.

Goal: To improve diagnostic and treatment outcomes in children with dysfunctional voiding using transperineal ultrasound.

Materials and Methods: This observational single-center study with a non-randomized comparison group included 103 children aged 5–18 years with pelvic evacuation disorders treated at the N.F. Filatov Children’s City Clinical Hospital between 2018 and 2025.  All patients underwent transperineal ultrasound assessment of the pelvic floor, triple uroflowmetry with residual urine measurement, and electromyography of the perineal muscles.

Results: The cohort included 58 girls and 45 boys. Triple uroflowmetry demonstrated a 27% reduction in average urinary flow rate in boys, while girls showed values at the lower limit of normal. All patients exhibited intermittent or staccato voiding patterns. Electromyography revealed increased pelvic floor muscle activity during urination. Residual urine (10–30%) was detected in 53 children. A characteristic ultrasound finding was minimal displacement of the urethra and bladder neck during functional tests, indicating paradoxical pelvic floor activity. Enlarged puborectal loop dimensions, increased anal canal width, and decreased anorectal angle suggested anal sphincter hypercontractility and correlated with ultrasound findings.

Conclusions: Transperineal ultrasound is an effective, non-invasive diagnostic tool and may serve as a method of choice for evaluating dysfunctional voiding in children without requiring invasive or costly procedures.

Ekaterina Markina is a pediatric surgeon and pediatric urologist-andrologist. She is a postgraduate researcher at the Department of Pediatric Surgery of Pirogov Russian National Research Medical University, Moscow. She is currently conducting research toward her PhD (Candidate of Medical Sciences) degree, focusing on voiding dysfunction in children associated with pelvic floor pathology. Her academic and clinical work is dedicated to improving the diagnosis and management of lower urinary tract dysfunction in pediatric patients, with a particular interest in functional and anatomical aspects of pelvic floor disorders.