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Effect of biofeedback treatment on spinning top urethra in children with voiding dysfunction
Yusuf Kibar1, Erkan Demir, Cem Irkilata
1Department of Urology, Gulhane Military Medical Academy School of Medicine, Ankara, Turkey.
Insights
Biofeedback therapy significantly improves spinning top urethra (STU) deformity in children with voiding dysfunction. This treatment is more effective than timed voiding for STU and associated vesicoureteral reflux.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Urodynamics
Background:
- Spinning top urethra (STU) deformity is linked to detrusor instability and increased intravesical pressure.
- STU is frequently observed in children presenting with urinary infections or suspected bladder instability.
- The condition can be associated with vesicoureteral reflux.
Purpose of the Study:
- To evaluate the efficacy of biofeedback treatment for STU in children with dysfunctional voiding.
- To compare biofeedback therapy with simple bladder retraining and timed voiding.
Main Methods:
- A retrospective analysis of 121 children diagnosed with STU and voiding dysfunction.
- Patients were divided into two groups: bladder retraining with timed voiding (n=49) and biofeedback therapy (n=72).
- Voiding cystourethrography was performed at 6 and 12 months to assess STU status.
Main Results:
- Biofeedback therapy demonstrated significantly higher improvement rates for STU compared to timed voiding at both 6-month and 1-year follow-ups.
- Improvement was noted in children with STU and concurrent vesicoureteral reflux in the biofeedback group.
- The study included children aged 5-13 years, with a majority being girls in both treatment groups.
Conclusions:
- Biofeedback training is a simple, effective, and well-tolerated treatment for STU in children.
- STU should be considered in pediatric urology evaluations, especially when associated with urinary infections, bladder instability, or vesicoureteral reflux.
- Biofeedback offers a promising therapeutic option for pediatric patients with STU and voiding dysfunction.
Objectives:
Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding.
Methods:
A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies.
Results:
The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up.
Conclusions:
For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.
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