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Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with?
M İrfan Dönmez1, Ismail Selvi1, Tayfun Oktar1,2
1İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, İstanbul University, Istanbul, Turkey.
Lower Urinary Tract Symptoms
|June 26, 2024
Summary
Treatment-resistant dysfunctional voiding (DV) in children often requires combination therapies for success. While most children achieve clinical improvement, some may experience persistent symptoms despite multiple interventions.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Child Health
Background:
- Dysfunctional voiding (DV) is a common condition in children that can be challenging to treat.
- Treatment resistance in DV necessitates exploring alternative and combination management strategies.
- Pelvic floor biofeedback therapy (BF) is a primary treatment, but some children do not respond adequately.
Purpose of the Study:
- To analyze the effectiveness of various management strategies for children with treatment-resistant dysfunctional voiding (DV).
- To identify successful combination treatments for children who did not respond to initial urotherapy and biofeedback.
- To evaluate outcomes in a cohort of pediatric patients with refractory DV.
Main Methods:
- Retrospective review of 16 children with DV who showed incomplete response to urotherapy and initial pelvic floor biofeedback therapy (BF).
- Analysis of demographic and clinical characteristics, DVSS, and uroflowmetry parameters before and after initial BF.
- Documentation of subsequent treatments, including anticholinergics, TENS, salvage BF sessions, and Botulinum-A injections, and their clinical responses.
Main Results:
- A total clinical success rate of 87.5% was achieved after a median follow-up of 24 months.
- Combination treatments, including anticholinergics, TENS, and salvage BF sessions, were effective in the majority of cases.
- Significant improvements were observed in voiding efficiency (VV-EBC), maximum flow rate (Qmax), and reduction in DVSS and post-void residual volume (PVR-EBC).
Conclusions:
- Various combination treatments can achieve clinical success in the majority of children with treatment-resistant dysfunctional voiding (DV).
- A small subset of children may continue to experience bothersome symptoms despite comprehensive treatment approaches.
- Salvage therapies and combination regimens are crucial for managing refractory pediatric DV.
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