Physical therapy of non-neurogenic voiding dysfunction in children with occult spinal dysraphism

In children with occult spinal dysraphism one of the symptoms is disbalance in bladder emptying and filling. Goal of our study was to estimate the correlation of medicamentous treatment alone and combined medicamentous and physical treatment in patients that are diagnosed with occult spinal dysraphism with non-neurogenic bladder dysphunction.

We evaluated 69 patients aged from 4 to 12 years treated at the University children's Hospital in Belgrade during 2005-2008 years period. In the first group of 29 patients only medicamentous therapy was implemented. In the second group of 40 patients combined medicamentous and physical therapy were applied. Physical therapy methods that were used included: transcutaneal electric nerve stimulation and exponential current. We monitored daily enuresis, enuresis nocturna, urgency and frequency. Urodynamic evaluation included: bladder capacity, onset of unstable contractions, residual urine and detrusor sphincter dyssynergia.

Statistical analysis showed that there is significant improvement (p < 0.001) in all evaluated symptoms after 6 months and for urgency there was significant improvement (p < 0.05) after 3 months from the beginning of the treatment with combined therapy. Our study pointed out significant improvement in the group treated with combined therapy for detrusor sphincter dyssynergia and unstable contractions after 3 months while after 6 months from the beginning of the treatment there was significant improvement (p < 0.001) for all urodynamic parameters.

Combined medicamentous and physical treatment is more beneficial for patients with non-neurogenic bladder instead of medicamentous treatment alone (Tab. 2, Ref. 11).