PEDIATRIC UROLOGY High efficacy of biofeedback therapy for treatment of dysfunctional voiding in children

Abstract

IntroductionDysfunctional voiding is a frequent condition in children associated with symptoms of incontinence. The aim of this study was to present the efficacy of biofeedback treatment on the resolution of clinical symptoms in a large cohort of children with urodynamically confirmed dysfunctional voiding.Material and methods81 children (75 girls and 6 boys) aged 6-18 years (mean: 10.32 ±3.17 yrs.) with a dysfunctional voiding pattern are presented. 74/81 (92.6%) of children were unresponsive to standard urotherapy and prior pharmacotherapy. Symptoms of bladder dysfunction were evaluated by questionnaire, bladder diary and an urodynamic study according to definitions and standards set by ICCS. The biofeedback training was planned for 2 months. Each session consisted of about 30 repeats of 5 s contraction and 30 s relaxation of pelvic floor muscles and external urethral sphincter. Biofeedback was performed together with standard urotherapy.Results67 (82.72%) of the 81 children declared wetting during the day and 41 (50, 62%) – wetting during the night. 32/81 (39.5%) children had increased voiding frequency and 43 (53.08%) had decreased bladder capacity. Following 2 months of biofeedback therapy daytime incontinence resolved in 34/67 (50.7%) children and nighttime incontinence in 22/41 (53.65%). A further 40,3% declared partial improvement in daytime and 26.7% in nighttime wetting.ConclusionsBiofeedback treatment is an effective therapeutic option for children with dysfunctional voiding. Pelvic floor therapy with biofeedback should be offered to children with dysfunctional voiding resistant to standard urotherapy.

Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

“…Similarly, another study by Kibar and colleagues reported a significant improvement in outcomes in children with DV using combined urotherapy plus biofeedback compared with standard urotherapy ( 2 ). Another study reported that symptomatic healing was observed in 50% of children with urotherapy - resistant DV who were treated with biofeedback ( 21 ). In recent years, biofeedback therapy has been increasingly used in children with DV.…”

The efficacy of physiotherapeutic intervention with biofeedback assisted pelvic floor muscle training in children with dysfunctional voiding

“…The relatively high percentage of children on anticholinergics may also account for the less pronounced effect compared to prior studies. [16,22,26,27] The limitations of the present study are the relatively small patient cohort, a short followup period, the non-controlled study design and the lack of any symptom questionnaire J o u r n a l P r e -p r o o f data or voiding diaries. Also, 7% of the children were assessed not to be adequately treated for constipation at the commence to treatment, and some children were on other medications including prophylactic antibiotics and anticholinergics during treatment, which could influence the results.…”

The effect of biofeedback treatment for children with non‐neurogenic voiding dysfunction: A systematic review and meta‐analysis

“…The other 8 studies 18,19,23,24,[27][28][29][30] can only be qualitatively analyzed because of the incomplete results.…”

“…In addition, seven studies 19,23,24,[27][28][29][30] didn't provide initial values before standard treatment and one study 18 didn't report results at the endpoint of 6 or 12 months, so we could only perform qualitative analysis on them. The results are shown in Table 4.…”