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Biofeedback as a first-line treatment for overactive bladder syndrome refractory to standard urotherapy in children
Turgay Ebiloglu1, Engin Kaya2, Burak Köprü3
1Etimesgut Military Hospital, Department of Urology, Ankara, Turkey.
Insights
Biofeedback therapy is effective for children with overactive bladder (OAB) refractory to standard urotherapy, showing significant symptom improvement. This approach offers a viable first-line treatment option when initial therapies are unsuccessful.
Area of Science:
- Pediatric Urology
- Behavioral Medicine
- Lower Urinary Tract Dysfunction
Background:
- Overactive bladder syndrome (OAB) and dysfunctional voiding (DV) are common forms of lower urinary tract dysfunction (LUTD) in children.
- Standard urotherapy is the primary treatment for OAB, but some patients do not respond adequately.
Purpose of the Study:
- To evaluate biofeedback as a first-line treatment for pediatric OAB resistant to standard urotherapy.
- To identify factors influencing the effectiveness of biofeedback therapy in this population.
Main Methods:
- Retrospective analysis of 136 children diagnosed with OAB who were refractory to standard urotherapy.
- Defined OAB symptoms including urgency, urge incontinence, and holding maneuvers.
- Assessed successful biofeedback therapy by the resolution of these symptoms.
Main Results:
- Biofeedback therapy achieved a 53% overall success rate in resolving urgency among 136 OAB patients.
- Significant recovery rates were observed for holding maneuvers (61%), urgency incontinence (69%), daytime incontinence (66%), enuresis (89%), and dysuria (69%).
- The mean lower urinary tract symptom score (LUTSS) significantly decreased from 16.38 to 8.18 (p < 0.001).
Conclusions:
- Biofeedback therapy demonstrates significant efficacy in treating pediatric OAB that is refractory to standard urotherapy.
- It can be considered a valuable first-line treatment option for children with OAB when initial urotherapy fails.
- Factors such as absence of holding maneuvers, daytime incontinence, and enuresis were associated with better recovery outcomes.
Introduction:
Overactive bladder syndrome (OAB) and dysfunctional voiding (DV) are subgroups of lower urinary tract dysfunction (LUTD). Standard urotherapy is the first-line treatment option of OAB in children.
Objectives:
The aim was to investigate the use of biofeedback as a first-line treatment option in OAB refractory to standard urotherapy, and determine the factors affecting efficacy.
Study Design:
Between 2005 and 2015, we retrospectively analyzed a total of 136 hospital records of children with OAB who had not previously used any anticholinergics and were refractory to standard urotherapy. Patients with urgency and/or urge incontinence and/or making holding maneuvers to suppress urgency were defined as having OAB symptoms, and resolution of these complaints was defined as successful biofeedback therapy.
Results:
Seventy-three of 136 OAB patients' urgency recovered by biofeedback therapy with the success rate of 53% (p < 0.001). Sixty-two of 101 patients with holding maneuvers (success rate 61%) (p < 0.001), 70 of 101 patients with urgency incontinence (success rate 69%) (p < 0.001), 76 of 114 patients with daytime incontinence (success rate 66%) (p = 0.023), 87 of 97 patients with enuresis (success rate 89%) (p = 0.009), and 27 of 39 patients with dysuria (success rate 69%) (p = 0.007) recovered from their symptoms significantly. The mean lower urinary tract symptom score (LUTSS) was 16.38 and 8.18 before and after biofeedback therapies, respectively (p < 0.001) (Table). Patients without holding maneuvers (p = 0.045), daytime incontinence (p = 0.030), and enuresis (p = 0.045) had better recovery compared to the opposites.
Discussion:
Biofeedback can be thought of as the first-line treatment option when standard urotherapy fails in children with OAB.
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