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Maintenance biofeedback therapy for dysfunctional voiding: Does every child need it?
Muhammet İrfan Dönmez1, Ismail Selvi1, Elif Dereli1
1Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Insights
Biofeedback therapy (BF) effectively treats dysfunctional voiding (DV) in children, achieving 75% initial success. Maintenance BF ensures success in all patients, with higher symptom scores predicting relapse risk.
Area of Science:
- Pediatric Urology
- Rehabilitation Medicine
- Clinical Outcomes Research
Background:
- Dysfunctional voiding (DV) is a common pediatric urological condition.
- Biofeedback therapy (BF) is a recognized treatment for DV.
- Long-term outcomes and relapse rates in pediatric DV patients treated with BF require further analysis.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of biofeedback therapy (BF) in children with dysfunctional voiding (DV).
- To identify predictors for clinical relapse and the need for maintenance BF sessions.
- To determine the efficacy of maintenance BF in achieving sustained clinical success.
Main Methods:
- Retrospective review of 64 children (mean age 8.89 years) with DV treated with BF (2013-2020).
- Exclusion of patients with neurological or anatomical abnormalities.
- Analysis of demographic data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters before and after initial and maintenance BF sessions.
Main Results:
- Initial clinical success with BF was achieved in 75% of patients (48/64) after a median of 6 sessions.
- Symptom relapse occurred in 20.8% of initially successful patients within 24 months.
- Maintenance BF sessions led to clinical success in all patients, with higher post-initial DVSS predicting the need for maintenance.
Conclusions:
- Biofeedback therapy demonstrates high initial efficacy for pediatric dysfunctional voiding.
- A significant proportion of patients may experience relapse, necessitating consideration of maintenance therapy.
- Dysfunctional voiding symptom scores after initial BF are valuable predictors for identifying patients who may require ongoing treatment.
Objectives:
The aim of the present study is to analyze the long-term clinical outcomes in children who were treated with biofeedback therapy (BF) for dysfunctional voiding (DV) and to determine the need for maintenance of BF due to clinical relapse.
Methods:
Files of children with DV who underwent BF between 2013 and 2020 were retrospectively reviewed. Patients with neurological or anatomical problems were excluded. A total of 64 patients (52 girls, 12 boys) with a mean age of 8.89 ± 2.48 years who completed the initial BF sessions were included in the study. The demographic and clinical data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters were recorded before and after the initial BF sessions. Clinical success was regarded as the cessation of electromyography activity as well as concurrent resolution of lower urinary tract symptoms and improvement in uroflowmetry parameters. After the initial BF sessions, children who had initial success showed DV relapse at any time during follow-up received the maintenance BF sessions. Therefore, the patients with successful initial BF were divided into two groups: the group that needed maintenance BF, and the group which required no maintenance BF.
Results:
Clinical success was achieved in 48 (75.0%) of 64 children following a median of 6 sessions (range 2-8). At the follow-up, 10 (20.8%) out of 48 patients showed symptom relapse at a median of 8 months (range 2-24 months). After a median of 3.5 maintenance BF sessions (range 1-6), clinical success was observed in all patients. Both groups showed a significant DVSS decrease after initial BF, however, those who needed maintenance had significantly higher DVSS (6.80 ± 2.53 vs. 3.61 ± 1.12, p < 0.001). At admission, DVSS <17.5 (odds ratio [OR]: 4.31, p = 0.025) and post-voiding residual volume as a percentage of estimated bladder capacity for age <28.9 (OR: 5.00, p = 0.009) were found as the predictive factors for initial BF success. The need for maintenance BF was 2.56-fold higher with a DVSS above 5.5 after initial BF sessions.
Conclusions:
Our results show that despite a clinical success rate of 75% after the initial BF, relapse can be seen within 2 years in approximately 20% of the patients. Nevertheless, maintenance of BF may provide clinical success in all patients. Relatively higher DVSS after initial BF can be used as a predictor of the need for maintenance BF.
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