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Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games
P H McKenna1, C D Herndon, S Connery
1Department of Pediatric Urology, Connecticut Children's Medical Center, Hartford, USA.
Insights
Computer game-assisted pelvic floor muscle retraining offers a new, noninvasive outpatient method for children with voiding dysfunction. This therapy significantly improves continence, constipation, and encopresis, with objective gains in uroflowmetry-electromyography and reduced residual urine.
Area of Science:
- Pediatric Urology
- Pelvic Floor Rehabilitation
- Biofeedback Therapy
Background:
- Dysfunctional voiding in children often presents with enuresis, constipation, and encopresis.
- Traditional treatments may be invasive or less effective for certain pediatric populations.
- Objective measures like uroflowmetry-electromyography (UEMG) are crucial for diagnosing and monitoring voiding dysfunction.
Purpose of the Study:
- To evaluate a novel noninvasive outpatient method for pelvic muscle retraining in children.
- To assess the efficacy of computer game-assisted biofeedback for improving voiding dysfunction symptoms.
- To determine objective improvements in urodynamic parameters and pelvic floor muscle activity.
Main Methods:
- A cohort of children diagnosed with voiding dysfunction underwent a pelvic floor muscle retraining program using computer game-assisted biofeedback.
- Subjective improvements in diurnal enuresis, nocturnal enuresis, constipation, and encopresis were assessed via surveys.
- Objective assessments included pre- and post-treatment UEMG and post-void residual urine volume measurements.
Main Results:
- Significant subjective improvements were reported by over 80% of patients for diurnal enuresis, constipation, and encopresis by end treatment.
- Objective improvements included enhanced UEMG patterns in 42% and decreased post-void residual urine in 57% of patients.
- Pelvic floor muscle retraining demonstrated improved resting and contracting tone, with 78% showing better contraction post-therapy.
Conclusions:
- Computer game-assisted pelvic floor muscle retraining is an effective conservative management strategy for pediatric voiding dysfunction.
- The therapy leads to substantial subjective and objective improvements in continence, bowel function, and urodynamic parameters.
- This noninvasive approach offers a promising alternative for children experiencing complex voiding issues.
Purpose:
We evaluated a new noninvasive outpatient method of pelvic muscle retraining in children using computer game assisted biofeedback.
Materials And Methods:
All patients in whom voiding dysfunction was confirmed by history, uroflowmetry-electromyography and voiding cystourethrography were enrolled in a pelvic floor muscle retraining program. Patients received a pretreatment, mid treatment and posttreatment survey instrument documenting subjective improvement, including the frequency of diurnal enuresis, nocturnal enuresis, constipation and encopresis. Pretreatment and posttreatment simultaneous uroflowmetry surface electrode electromyography was performed and post-void residual urine volume was determined in all patients.
Results:
A total of 8 boys and 33 girls 5 to 11 years old (mean age 7.2) completed therapy and were available for evaluation. These patients completed 2 to 11 (average 6) hourly treatment sessions. Followup was 3 to 15 months (average 7). At the midterm evaluation improvement in nocturnal enuresis was reported by 57% of the patients, diurnal enuresis by 84%, constipation by 83% and encopresis by 91%. End treatment evaluation revealed improvement in nocturnal enuresis by 90% of patients, diurnal enuresis by 89%, constipation by 100% and encopresis by 100%. Uroflowmetry-electromyography patterns improved in 42% of the patients and post-void residual urine decreased in 57%. Comparison of initial to end recorded millivoltage pelvic floor muscle values demonstrated that 56% of the patients had lower resting tone at the beginning of the session after completing therapy and 78% had improved contracting tone after performing Kegel exercises, as proved by increased microvoltage values. Initial uroflowmetry-electromyography revealed certain categories of cases, including a flattened voiding curve with a hyperactive pelvic floor and low post-void residual urine in 40%, a flattened voiding curve with a hyperactive pelvic floor and high post-void residual urine in 40%, a staccato voiding curve with a hyperactive pelvic floor and low post-void residual urine in 3%, and a staccato voiding curve with a hyperactive pelvic floor and high post-void residual urine in 17%. Of the girls 91% presented with the classic spinning top deformity on voiding cystourethrography. A total of 22 patients presented with a significant history of recurrent urinary tract infections, and infection developed in 3 during treatment and followup. Vesicoureteral reflux in 14 patients resolved during treatment in 3, reimplantation was performed in 1 and 10 are still being observed.
Conclusions:
A program of conservative medical management with computer game assisted pelvic floor muscle retraining resulted in significant subjective improvement in continence, constipation and encopresis as well as objective improvement in uroflowmetry-electromyography, post-void residual urine volume and the microvoltage value of pelvic floor muscles in the majority of patients with dysfunctional voiding.