Dysfunctional voiding symptom survey in children

Over the last month	Almost never	Less than half the time	About half the time	Almost every time	Not available
1. I have had wet clothes or wet underwear during the day.	0	1	2	3	NA
2. When I wet myself, my underwear is soaked.	0	1	2	3	NA
3. I miss having a bowel movement every day.	0	1	2	3	NA
4. I have to push for my bowel movements to come out.	0	1	2	3	NA
5. I only go to the bathroom one or two times each day.	0	1	2	3	NA
6. I can hold onto my pee by crossing my legs, squatting, or doing the "pee dance".	0	1	2	3	NA
7. When I have to pee, I cannot wait.	0	1	2	3	NA
8. I have to push to pee.	0	1	2	3	NA
9. When I pee it hurts.	0	1	2	3	NA
10. Caregivers to answer: Has the child experienced something stressful, including the following: new baby at home, new home, new school, school or home problems, abuse, special events (birthday), or accident/injury?	No (0)			Yes (3)
Total

The questionnaire has been used in several pediatric urologic centers to assess for bladder dysfunction. In females, the threshold score suggestive of bladder dysfunction is >6 and in males, the threshold score is >9.

Reproduced from: Farhat W, Bägli DJ, Capolicchio G, et al. The dysfunctional voiding scoring system: Quantitative standardization of dysfunctional voiding symptoms in children. J Urol 2000; 164:1011. Table used with the permission of Elsevier Inc. All rights reserved.

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Dysfunctional voiding symptom survey in children