Efficacy of Electromyographic Biofeedback for Dysfunctional Voiding in Children and Adolescents: A Systematic Review...

To assess the efficacy of electromyographic biofeedback (EMGBF) in the treatment of dysfunctional voiding (DV) in children and adolescents by synthesizing evidence from randomized controlled trials.

We conducted a systematic review and meta-analysis of randomized and controlled trials evaluating EMGBF therapy in pediatric patients diagnosed with DV. Searches were performed across seven databases (Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Livivo, and LILACS) up to January 2025. Gray literature was also searched using Google Scholar, ProQuest, and medRxiv.

Four randomized controlled trials were included, totaling 244 patients. The meta-analysis showed that EMGBF therapy significantly increased maximum urinary flow rate (MD: 4.69; 95% CI: 1.06-8.31), normalized voiding flow patterns (RR: 2.70; 95% CI: 1.43-5.10), reduced postvoid residual urine (MD: 11.11; 95% CI: 2.38-19.84), and improved enuresis (RR: 2.34; 95% CI: 1.05-5.20). Additionally, a subset of 17 patients with vesicoureteral reflux (VUR) was evaluated. Among those who underwent EMGBF, VUR resolution was observed in all but one patient with grade IV reflux. Reported resolution rates were 88.8% at 6 months and 77.7% at 1 year in the intervention group, compared with 37.5% and 12.5%, respectively, in the control group. However, these findings should be interpreted with caution given the limited number of patients and lack of randomization for VUR-specific outcomes.

EMGBF is an effective and well-tolerated intervention for treating dysfunctional voiding in children and adolescents. Benefits include improvements in urinary symptoms, urodynamic parameters, and infection rates. Although preliminary findings suggest a possible positive effect on VUR, further high-quality trials are warranted to confirm these observations and to optimize therapeutic protocols.