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Effectiveness of biofeedback for dysfunctional elimination syndrome in pediatrics: a systematic review
Darren J Desantis1, Michael P Leonard, Mark A Preston
1Division of Pediatric Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
Insights
Biofeedback effectively treats dysfunctional elimination syndrome in children, with about 80% experiencing symptom improvement. This non-invasive therapy shows promise for conditions like UTIs and incontinence.
Area of Science:
- Pediatric Urology
- Non-invasive Therapies
- Voiding Dysfunction
Background:
- Dysfunctional elimination syndrome (DES) involves incomplete bladder emptying, leading to urinary tract infections (UTIs), incontinence, and constipation.
- Biofeedback offers a non-invasive treatment approach for DES, aiming to improve bladder emptying and reduce associated symptoms.
Purpose of the Study:
- To evaluate the efficacy of biofeedback as a treatment for dysfunctional elimination syndrome in children under 18 years of age.
- To synthesize evidence from existing literature on biofeedback's impact on primary outcomes like UTIs and daytime incontinence.
Main Methods:
- A comprehensive literature search was performed across major medical databases (MEDLINE, EMBASE, CINAHL, Cochrane) and conference abstracts.
- Data from 27 studies, including one randomized controlled trial and 26 case series, were quality assessed and abstracted by two independent reviewers.
- Primary outcomes analyzed were the resolution of UTIs and improvement in daytime incontinence.
Main Results:
- Biofeedback demonstrated significant improvement rates: 83% for UTIs and 80% for daytime incontinence.
- Additional improvements were observed in constipation (18%-100%), frequency (67%-100%), urgency (71%-88%), and vesicoureteral reflux (VUR) (21%-100%).
- While the single RCT favored biofeedback, results were not statistically significant; however, pooled analysis indicated broad efficacy.
Conclusions:
- Biofeedback is an effective, non-invasive treatment for dysfunctional elimination syndrome in children, benefiting approximately 80% of patients.
- Despite promising results, the majority of included studies had a low level of evidence.
- Further high-quality research, particularly randomized controlled trials, is recommended to solidify these findings.
Purpose:
Dysfunctional elimination syndrome is associated with an inability to effectively empty the bladder and may present with UTI, incontinence, intestinal constipation or other voiding symptoms. Biofeedback has emerged as one potentially effective and non-invasive treatment. We sought to analyze if biofeedback is an effective method to treat children less than 18 years of age.
Methods:
A literature search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Database, AUA, CUA, AAP and ESPU abstracts. Copies of all relevant articles were retrieved for quality assessment and data abstraction by two independent reviewers. Primary outcomes were UTIs and daytime incontinence.
Results:
27 studies were included (1 RCT and 26 case-series). The pooled estimate showed 83% (95% CI: 79%-86%) and 80% (95% CI: 76%-85%) improvement in UTI and daytime incontinence respectively. I(2) statistic showed "Low" (7%) and "High" (77%) heterogeneity across studies results for UTI and daytime incontinence. The only included RCT favored biofeedback over standard therapy (RR 1.4, 95% CI: 0.98-2.00) but this was not statistically significant. On analysis of all included studies there was also improvement in constipation (18%-100%), frequency (67%-100%), urgency (71%-88%) and VUR (21%-100%). PVR improvement ranged from 26 ml to 99 ml and Q(max) improvement was from 3.1 ml/s-4.7 ml/s.
Conclusion:
Based on this review, biofeedback is an effective, non-invasive method of treating dysfunctional elimination syndrome, and approximately 80% of children benefited from this treatment. However, most reports were of low level of evidence and studies of more solid design such as RCT should be conducted.
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