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Effectiveness of urotherapy and biofeedback treatment in dysfunctional voiding and factors affecting success
Bekir Erdeve1, Serdar Moralıoğlu1
1University of Health Sciences Turkey, Hamidiye Faculty of Medicine, Department of Pediatric Surgery, Istanbul Zeynep Kamil Women and Children's Diseases Health Training and Research Center, Zeynep Kamil Mahallesi, Dr. Burhanettin Ustunel Sokagi No:10, Uskudar, 34668, İstanbul, Turkey.
Insights
Urotherapy and biofeedback (UT/BF) effectively treat dysfunctional voiding in children, with high success rates regardless of patient characteristics like age or gender. This combined approach is a suitable first-line treatment for most pediatric patients.
Area of Science:
- Pediatric Urology
- Child Health
- Urological Dysfunction
Background:
- Dysfunctional voiding (DV) is a common cause of childhood morbidity, characterized by sphincter overactivity without anatomical or neurological deficits.
- Effective treatment strategies are crucial for improving quality of life in affected children.
Purpose of the Study:
- To evaluate the efficacy of urotherapy and biofeedback (UT/BF) in treating pediatric dysfunctional voiding.
- To identify factors influencing treatment outcomes in patients with DV.
Main Methods:
- Retrospective review of 174 UT/BF treatment cycles in 157 pediatric patients diagnosed with DV.
- Analysis of patient demographics, urodynamic parameters (UFM), and post-void residual (PVR) volume.
- Statistical analysis using Mann-Whitney U, Wilcoxon, chi-squared, Fisher's exact, and logistic regression tests.
Main Results:
- High treatment success rates were observed: 87% complete response per cycle and 88.54% complete response per patient.
- No statistically significant impact of age, gender, reason for admission, UFM parameters, or PVR volume on treatment success was found.
Conclusions:
- Combined urotherapy and biofeedback (UT/BF) demonstrate high efficacy in treating pediatric dysfunctional voiding.
- UT/BF is an appropriate first-line treatment option for all patient groups studied, irrespective of the analyzed characteristics.
- Further randomized controlled trials are recommended to solidify treatment guidelines.
Aim:
Dysfunctional voiding is the persistence of the sphincter activity during voiding without anatomical or neuropathic causes and is an important cause of morbidity in children. In this study, we aimed to determine the results of urotherapy and biofeedback treatments and the factors affecting the results in the patients with dysfunctional voiding.
Materials And Methods:
Patients who were diagnosed with dysfunctional voiding and received urotherapy and biofeedback treatments between July 2012 and March 2021, were included in the study. The patients' medical records were retrospectively reviewed. Complete and partial responses were defined as complete and partial improvement of the symptoms, respectively. Patients with a complete response were classified into one group, while patients with a partial response or no response were grouped into another. Nonparametric Mann-Whitney U test and Willcoxon test were used for continuous variables, chi-squared test and Fisher's exact test were used for discrete variables. The relationship was examined by multivariate and univariate logistic regression analysis. The results were evaluated with 95 % confidence interval and p < 0.05 significance level. IBM SPSS 20.0 was used for data analysis.
Results:
The study included 174 UT/BF cycles in 157 patients. Treatment success was complete response in 152 (87 %) cycles. Patient based treatment success was complete response in 139 (88.54 %) of 157 patients, and partial response or no response in 18 (11.46 %) patients. The effects of age, gender, reason for admission, UFM parameters, and PVR volume were not statistically significant.
Discussion:
The combination of standard urotherapy and biofeedback is widely used to treat patients with dysfunctional voiding. We evaluated the efficacy of these treatments and the factors affecting the results. Our study has limitations due to its retrospective design. Strengths of the study include a standardized approach with a single, experienced surgeon and long follow-up periods. The treatment of dysfunctional voiding is still debated in the literature, and randomized controlled trials with sufficient number of patients should be conducted to determine the most appropriate treatment approach.
Conclusion:
When analyzing patient characteristics, we found that age, gender, reason for admission, UFM parameters and PVR volume had no impact on treatment success, Therefore, UT/BF appears to be an appropriate first-line treatment in all these groups.
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