OBJECTIVE To retrospectively evaluate the role of video-urodynamics (VUD) in the diagnosis and management of voiding dysfunction in children. METHODS The records of the 128 children with dysfunctional voiding symptoms were retrospectively evaluated. All patients had a noninvasive screening assessment consisting of a detailed voiding history, ultrasonography and uroflowmetry, and measurement of residual urine. All the patients had also undergone VUD with no selection criteria. The results of VUD were compared retrospectively with the noninvasive screening assessment results. RESULTS In 84 patients with urge syndrome VUD showed detrusor overactivity in 72 (86%); the bladder configuration and voiding-phase results were normal. Three (3.5%) patients had low-grade reflux. In 38 patients with voiding dysfunction VUD showed an intermittent flow pattern and/or increased electromyographic activity with a "spinning top" deformity of the bladder neck and increased detrusor pressure during voiding. Five (13%) of these children had low-grade reflux. In six infrequent voiders VUD revealed increased bladder capacity with fractionated flow patterns, with concomitantly increased abdominal pressures. There was decreased detrusor pressure during voiding with significant residual urine volume in only two patients; there was no reflux in any of the patients in this group. CONCLUSIONS We do not recommend routine VUD in children with non-neurogenic voiding dysfunction, as it does not generally change the management and treatment. A detailed voiding history and physical examination is usually sufficient for a correct diagnosis.