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Pelvic floor rehabilitation in children with functional LUTD: does it improve outcome?
Anka J Nieuwhof-Leppink1, Frank-Jan van Geen2, Elise M van de Putte3
1Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
Insights
Pelvic floor rehabilitation using biofeedback with anal balloon expulsion (BABE) did not improve incontinence outcomes in children when added to intensive urotherapy. Intensive urotherapy alone demonstrated superior results for treating functional lower urinary tract dysfunction (LUTD).
Area of Science:
- Pediatric Urology
- Functional Voiding Disorders
- Pelvic Floor Rehabilitation
Background:
- Standard urotherapy may not sufficiently relieve lower urinary tract dysfunction (LUTD) in children.
- Limited knowledge exists on the efficacy of pelvic floor rehabilitation for functional voiding disorders.
Purpose of the Study:
- To compare the effectiveness of pelvic floor rehabilitation via biofeedback with anal balloon expulsion (BABE) against intensive urotherapy for children with functional LUTD and inadequate pelvic floor control.
Main Methods:
- A retrospective chart study included 52 children with functional incontinence and inadequate pelvic floor control.
- Patients received either BABE before or after intensive inpatient urotherapy.
- Treatment success was measured using International Children's Continence Society criteria.
Main Results:
- Intensive urotherapy yielded significantly better results than BABE in both treatment rounds (Round 1: 70% vs 12%; Round 2: 92% vs 34%).
- Adding BABE to urotherapy did not show a significant additional benefit (P = .355).
- 58% of children who received BABE showed improvement in pelvic floor control.
Conclusions:
- Pelvic floor rehabilitation using BABE does not enhance the effectiveness of intensive urotherapy for treating childhood incontinence.
- Intensive urotherapy, incorporating real-time uroflowmetry biofeedback, appears more effective.
- The study suggests discouraging the use of BABE due to its invasive nature and lack of proven additional benefit.
Introduction:
If children do not experience satisfactory relief of lower urinary tract dysfunction (LUTD) complaints after standard urotherapy is provided, other treatment options need to be explored. To date, little is known about the clinical value of pelvic floor rehabilitation in the treatment of functional voiding disorders.
Objective:
Therefore, we compared pelvic floor rehabilitation by biofeedback with anal balloon expulsion (BABE) to intensive urotherapy in the treatment of children with inadequate pelvic floor control and functional LUTD.
Study Design:
A retrospective chart study was conducted on children with functional incontinence and inadequate pelvic floor control. All children referred for both intensive inpatient urotherapy and pelvic floor rehabilitation between 2010 and 2018 were considered for inclusion. A total of 52 patients were eligible with 25 children in the group who received BABE before inpatient urotherapy, and 27 children in the group who received BABE subsequently to urotherapy. Main outcome measurement was treatment success according to International Children's Continence Society criteria measured after treatment rounds and follow-up.
Results:
Baseline characteristics demonstrate no major differences between the BABE and control group. There was a significant difference in improvement between BABE and inpatient urotherapy after the first and second round of treatment (round 1: BABE vs urotherapy; 12% vs 70%, respectively, round 2: urotherapy vs BABE; 92% vs 34%, respectively, both P < .001). In both cases, the urotherapy group obtained greater results (Fig. 1). When the additional effect of BABE on urotherapy treatment is assessed, no significant difference is found (P = .355) in the children who received BABE; 30 (58%) showed improvement on pelvic floor control.
Discussion:
Our findings imply that training pelvic floor control in combination with inpatient urotherapy does not influence treatment effectiveness on incontinence. Intensive urotherapy contains biofeedback by real-time uroflowmetry; children receive direct feedback on their voiding behaviour. Attention offered to the child and achieving cognitive maturity with corresponding behaviour is of paramount importance. It is known that combining several kinds of biofeedback does not enhance the outcome. However, our results do not provide a conclusive answer to the effectiveness of pelvic floor physical therapy in the treatment of children with LUTD because we specifically investigated BABE.
Conclusion:
In this study, we could not prove that pelvic floor rehabilitation by BABE has an additional effect on inpatient urotherapy on incontinence outcomes. Considering the invasive nature of BABE, the use of BABE to obtain continence should therefore be discouraged.
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