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The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding
C Pfister1, J N Dacher, S Gaucher
1Department of Urology, Paediatric Surgery, Rouen University Hospital, Rouen, France.
Insights
Minimal urodynamic evaluation effectively diagnosed detrusor-sphincter dyscoordination in children. Pelvic floor biofeedback successfully treated this condition, leading to significant clinical improvement and resolution of symptoms.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pelvic Floor Rehabilitation
Background:
- Chronic voiding dysfunction in children presents diagnostic challenges.
- Detrusor-sphincter dyscoordination (DSdc) is a significant cause of lower urinary tract symptoms.
- Current management often requires specialized urodynamic assessment.
Purpose of the Study:
- To evaluate a minimal urodynamic approach for diagnosing pediatric voiding dysfunction.
- To assess the efficacy of pelvic floor biofeedback in managing detrusor-sphincter dyscoordination.
- To correlate urodynamic findings with clinical outcomes in children.
Main Methods:
- A cohort of 120 children with chronic voiding dysfunction underwent minimal urodynamic evaluation including flowmetry and sphincter electromyography (EMG).
- Children diagnosed with DSdc received initial urinary training followed by pelvic floor biofeedback if needed.
- Voiding cysto-urethrography was performed for patients with urinary tract infection or renal dilatation.
Main Results:
- Detrusor-sphincter dyscoordination (DSdc) was diagnosed in 28% of children.
- Pelvic floor biofeedback was administered to 15 children and resulted in resolution of DSdc on EMG and significant clinical improvement.
- Vesico-ureteric reflux was noted in 24 patients, with 10 associated with DSdc; reflux resolved in 10 children.
Conclusions:
- Minimal urodynamic evaluation is a valuable tool for diagnosing DSdc in children with chronic voiding dysfunction.
- Pelvic floor biofeedback demonstrates excellent outcomes for treating DSdc, improving urinary tract infections and bladder overactivity.
- This approach offers an effective management strategy for pediatric voiding dysfunction.
Objective:
To report our experience of assessing children with chronic voiding dysfunction (>6 months' duration) using a minimal urodynamic evaluation, and the management of detrusor-sphincter dyscoordination (DSdc) using pelvic floor biofeedback.
Patients And Methods:
From 1994 to 1997, 120 children (mean age 7.5 years) with three predominant and associated symptoms were referred to one urologist; they had nocturnal enuresis (28 children), urge incontinence (42) or urinary tract infection (50). All patients were assessed by urinary culture, renal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flowmetry with sphincter electromyography (EMG) using perineal surface electrodes. If they had urinary tract infection and/or renal dilatation, they underwent voiding cysto-urethrography. In children with DSdc, urinary training with frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory.
Results:
DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico-ureteric reflux was detected in 24 patients, associated with DSdc in 10. The reflux resolved spontaneously on antibiotic prophylaxis in six children and after urinary re-education in four.
Conclusion:
A minimal urodynamic evaluation seems to be useful in the diagnosis of DSdc which caused urinary tract infection and/or bladder overactivity. The results with pelvic floor biofeedback were excellent in these children.
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