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Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical
Seyedeh-Sanam Ladi-Seyedian1, Lida Sharifi-Rad1,2, Erfan Amini1
1Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, 4194 33151, Tehran, Iran.
Insights
Biofeedback therapy effectively treats dysfunctional voiding (DV) and hydronephrosis in children. This approach significantly improves urine flow rates and voiding diary parameters compared to standard urotherapy alone.
Area of Science:
- Pediatric Urology
- Biofeedback Therapy
- Pelvic Floor Muscle Exercises
Background:
- Dysfunctional voiding (DV) in children can be associated with mild to moderate hydronephrosis.
- Standard urotherapy is a common treatment, but additional therapies may improve outcomes.
Purpose of the Study:
- To assess the efficacy of biofeedback therapy combined with home pelvic floor muscle exercises in children with DV and hydronephrosis.
- To compare outcomes between a group receiving biofeedback therapy plus standard urotherapy and a control group receiving only standard urotherapy.
Main Methods:
- A prospective study involving 57 children (mean age 8.9 years) with DV and mild to moderate hydronephrosis.
- Random allocation into a control group (standard urotherapy) and a case group (biofeedback therapy + standard urotherapy).
- Baseline and follow-up assessments (6 months, 1 year) included voiding diaries, ultrasounds, uroflowmetry, and electromyography (EMG). Excluded were children with complete obstruction or vesicoureteral reflux.
Main Results:
- The biofeedback group showed a more significant decline in anteroposterior pelvic diameter compared to the control group (P < 0.05).
- Mean maximal urine flow rate significantly increased in the biofeedback group 1 year post-treatment (25 ml/s) compared to controls (18.4 ml/s; P < 0.001).
- Improvements in voiding diary parameters were more significant in the biofeedback group.
Conclusions:
- Biofeedback therapy, in conjunction with standard urotherapy, is effective in resolving non-refluxing and non-obstructive hydronephrosis in children with dysfunctional voiding.
- This combined approach offers significant benefits in improving urodynamic parameters and clinical outcomes.
Abstract:
We assessed efficacy of biofeedback therapy and home pelvic floor muscle exercises in children with dysfunctional voiding (DV) associated with mild to moderate hydronephrosis. This prospective study comprised fifty seven children (21 boys, 36 girls; mean age 8.9 ± 2.6) with DV and mild to moderate hydronephrosis. Children were randomly allocated into two treatment groups including control group who underwent standard urotherapy and case group who received biofeedback therapy in addition to standard urotherapy. A 99mTc diethylenetriamine pentaacetic acid (99mDTPA) scan, voiding cystoureterography, kidney and bladder ultrasounds, voiding diary and uroflowmetry with electromyography (EMG) were performed in all study participants at the baseline. Children with evidence of complete obstruction in DTPA scan and vesicoureteral reflux were excluded from enrollment. A complete voiding diary, kidney and bladder ultrasounds and uroflowmetry/EMG were also performed 6 months and 1 year after completion of the treatment. We noted a more significant decline in anteroposterior pelvic diameter in case group compared to control group (P < 0.05). The mean maximal urine flow rate prior to treatment was 16.5 ± 2.6 and 16.1 ± 3 ml/s in case and control groups, respectively. This finding increased significantly 1 year after the treatment in case group compared to controls (25 ± 7.2 ml/s vs. 18.4 ± 5.9 ml/s, respectively; P < 0.001). Improvement of various parameters in voiding diary was also more significant in the case group. Biofeedback therapy can effectively resolve non-refluxing and non-obstructive hydronephrosis in children with DV.
