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Biofeedback training for detrusor overactivity in children
T Yamanishi1, K Yasuda, N Murayama
1Departments of Urology and Neurology, School of Medicine, Chiba University and Department of Urology, Dokkyo University Medical School, Koshigaya Hospital, Saitama, Japan.
Insights
Biofeedback training effectively treats pediatric incontinence caused by detrusor overactivity, even when other treatments fail. This method improves bladder control and reduces urinary symptoms in children.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pelvic Floor Rehabilitation
Background:
- Detrusor overactivity is a common cause of pediatric incontinence.
- Conventional treatments often fail in refractory cases.
- Biofeedback offers a non-invasive therapeutic approach.
Purpose of the Study:
- To evaluate the efficacy of biofeedback training for treating pediatric incontinence.
- To assess the impact of biofeedback on urodynamic parameters in children with detrusor overactivity.
Main Methods:
- A cohort of 39 children (22 boys, 17 girls) with refractory detrusor overactivity and incontinence were enrolled.
- Urodynamic studies were conducted to assess bladder function and sphincter activity.
- Biofeedback training involved instructing patients to contract anal sphincters to inhibit detrusor contractions.
Main Results:
- Of 35 participants completing the study, 23 were cured and 4 improved.
- Urodynamic studies showed resolution or improvement in detrusor overactivity in 28 of 33 children.
- Significant increases in bladder capacity were observed post-treatment.
Conclusions:
- Biofeedback training is a viable and effective treatment for pediatric incontinence secondary to detrusor overactivity.
- The therapy demonstrates success even in cases resistant to conventional medical and behavioral interventions.
Purpose:
We evaluated biofeedback training for incontinence due to detrusor overactivity in children.
Materials And Methods:
Included in our study were 22 boys and 17 girls with a mean age of 11.2 years. We noted nighttime incontinence in 3 patients, nighttime incontinence and daytime urinary symptoms in 26, and daytime incontinence in 10. All patients had detrusor overactivity and incontinence refractory to conventional treatment, including bladder training, tricyclic antidepressants, anticholinergics, desmopressin and/or conditioning therapy. Urodynamic study was performed using an 8Fr double lumen transurethral catheter for cystometry, a double balloon transrectal catheter for rectal pressure and external anal sphincter pressure measurement, and surface electrodes for sphincter electromyography. During biofeedback training patients were instructed to contract the anal sphincter without raising abdominal pressure to inhibit overactive bladder contractions. Biofeedback training was repeated monthly until cystometry revealed a stable bladder or lower urinary tract symptoms improved considerably.
Results:
Four patients were lost to followup. Of the remaining 35 children urinary symptoms were cured in 23 and improved in 4. Urodynamic studies after 6 months of biofeedback training in 33 cases showed that bladder overactivity disappeared in 10 and improved in 18. Bladder capacity at the initial desire to void and maximum cystometric capacity increased significantly (p = 0.0115 and <0.0001, respectively). Detrusor-sphincter dyssynergia in 2 patients before biofeedback training resolved in each after therapy.
Conclusions:
Biofeedback training for detrusor overactivity is effective even in pediatric cases refractory to conventional treatment.