Urodynamic biofeedback training for children with bladder‐sphincter dyscoordination during voiding

Abstract

Neurologically normal children with recurrent urinary tract infections (UTIs), night- and daytime wetting, and urge and painful voiding may have staccato voiding due to pelvic floor contractions. The immediate effect of non-invasive urodynamic biofeedback (BF) therapy was assessed using a historical follow-up study in 31 children aged 5-15 years suffering from urodynamically proven overactive urethra during voiding. A long-term follow-up study was performed to investigate whether improvement was maintained. Twenty-four children (77.5%) benefited from the treatment. Of these 16 (51.5%) were cured, while 8 (26%) had a pronounced reduction in their symptoms. Although the flow was normalized in 17 (55%) and nearly normalized in 7 (22.5%), there was no significant correlation between subjective and objective criteria of improvement. Similarly, no relationship was found between the initial urodynamic characteristics and the treatment outcome. During a mean follow-up time of 4 years (range: 1-7.5 years) two of the initially cured patients relapsed. They were recurred with a refresher course. Three had had a single or a few episodes of cystitis in the course of several years. Of the patients with pronounced reduction in their symptoms, three relapsed. A refresher course was attempted in two patients; one was successful. It can thus be concluded that BF is an effective way of treating this disturbance and the beneficial effect is to a wide degree maintained.

Urinary Incontinence and Urinary Tract Infection and Their Resolution With Treatment of Chronic Constipation of Childhood

“…22,23 More recently, biofeedback treatment directed toward teaching external urethral sphincter/pelvic floor relaxation during voiding using perineal, vaginal, or anal placed surface electrodes for electromyogram has been reported. 20,21 Kunin et al 24 reported the prevalence rate for recurrent urinary tract infections in children to be .04% in boys and 1.1% in girls in a community-wide survey of school children in Virginia. We observed a 3% rate for urinary tract infection in constipated boys and a 33% rate in constipated girls.…”

“…4,5,16,20,21 The treatment of these children may include timed voiding, anticholinergics, and continuous administration of prophylactic antibiotics. 22,23 More recently, biofeedback treatment directed toward teaching external urethral sphincter/pelvic floor relaxation during voiding using perineal, vaginal, or anal placed surface electrodes for electromyogram has been reported.…”

Annotation: Day and Night Wetting in Children—A Paediatric and Child Psychiatric Perspective

“…With a limited number of between 1 and 9 training sessions, half of 32 children achieved complete and a quarter achieved partial success, with coordinated micturitions and long-term stability (Kjolseth et al, 1993). Also, the daytime wetting often subsides 443 DAY AND NIGHT WETTING spontaneously (Olbing, 1993), while concomitant nighttime wetting can be treated effectively.…”

Biofeedback bei kindlichen Blasenfunktionsst�rungen

“…Detrusor-SphinkterDyskoordination [27] "Dysco-ordinated voiding" [12] "Bladder sphincter incoordination" [18] "Bladder-sphincter dyscoordination" [22] "Vesical sphincter dyssynergia" [23] "Idiopathic detrusor sphincter dyssynergia" Eine chronische Obstipation ist neben der Harninkontinenz eine weitere Indikation für das Biofeedbacktraining [2,31]. Ein Zusammenhang einer Dysfunktion von Blase und Darm ist bekannt, die Mechanismen sind aber bislang ungeklärt [33].…”

“…Während des Trainings sollten die Patienten, hier die Kinder mit Harninkontinenz, den physiologischen Prozess zu erfassen und unter regelmäßiger Kontrolle zu korrigieren lernen [22]. Ziel ist, in einem weiteren Schritt das Erlernte auch ohne kontinuierliche bewusste Kontrolle umsetzen zu können (⊡ Tabelle 3).…”