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Hypopressive physiotherapy for refractory non-neurogenic underactive bladder in children: a retrospective case series
Iván Somoza Argibay1, Miriam García González2, Silvia Seoane Rodríguez3
1Department of Pediatric Surgery, Grupo Emergente de Investigación en Ingeniería Biomédica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Hospital Universitario A Coruña, A Coruña, Spain.
Insights
Hypopressive physiotherapy significantly reduced post-void residual (PVR) volumes in children with refractory underactive bladder (UAB). This intervention also resolved recurrent urinary tract infections (UTIs) and decreased the need for clean intermittent catheterization (CIC).
Area of Science:
- Pediatric Urology
- Physiotherapy
- Pelvic Floor Rehabilitation
Background:
- Pediatric non-neurogenic underactive bladder (UAB) presents with reduced detrusor contractility, elevated post-void residual (PVR) volumes, and recurrent urinary tract infections (UTIs).
- Standard urotherapy and pelvic floor rehabilitation are first-line treatments, but clean intermittent catheterization (CIC) is often necessary for refractory cases.
- Hypopressive physiotherapy, beneficial in adults, lacks systematic evaluation in pediatric UAB.
Purpose of the Study:
- To assess the clinical effectiveness of a structured hypopressive physiotherapy program as a urotherapy intervention for children with refractory non-neurogenic UAB.
Main Methods:
- A retrospective case series of six children with refractory non-neurogenic UAB and baseline PVR >50 mL.
- Participants underwent a structured hypopressive physiotherapy program.
- Evaluated PVR, UTIs, CIC requirements, and uroflowmetry at baseline, 6 months, and 12 months, using Wilcoxon signed-rank test for comparisons.
Main Results:
- Mean baseline PVR (123.3 mL) significantly decreased to 29.2 mL at 6 months (p=0.031) and 12.5 mL at 12 months (p=0.028).
- All patients achieved PVR ≤20 mL, recurrent UTIs resolved, and one patient discontinued CIC.
- Uroflowmetry curves showed partial normalization in three patients.
Conclusions:
- Hypopressive physiotherapy demonstrated significant reductions in PVR in children with refractory UAB.
- The intervention effectively resolved UTIs and reduced CIC dependence in this cohort.
- Findings support further prospective controlled studies on hypopressive physiotherapy for pediatric UAB.
Background:
Pediatric non-neurogenic underactive bladder (UAB) is characterized by reduced detrusor contractility, elevated post-void residual (PVR), and recurrent urinary tract infections (UTIs). Standard urotherapy and pelvic floor rehabilitation constitute first-line management, whereas clean intermittent catheterization (CIC) is frequently required in refractory cases. Hypopressive physiotherapy has shown benefit in adult pelvic floor dysfunction but has not been systematically evaluated in pediatric UAB.
Objective:
To evaluate the clinical effectiveness of a structured hypopressive physiotherapy program as a specific urotherapy intervention in children with refractory non-neurogenic UAB.
Methods:
A retrospective case series including six children with refractory non-neurogenic underactive bladder and baseline post-void residual volume >50 mL despite previous conservative treatment. All underwent a structured hypopressive physiotherapy program. Post-void residual volume, urinary tract infections, clean intermittent catheterization requirement, and uroflowmetry findings were evaluated at baseline, 6 months, and 12 months. Paired comparisons were performed using the Wilcoxon signed-rank test.
Results:
Six children were included, including two with bladder dysfunction secondary to previously treated congenital lower urinary tract obstruction (posterior urethral valves and ureterocele, respectively). Mean baseline PVR was 123.3 ± 20.5 mL. At 6 months, mean PVR decreased to 29.2 ± 16.9 mL (p = 0.031). At 12 months, mean PVR was 12.5 ± 9.9 mL (p = 0.028). All patients achieved PVR ≤20 mL during follow-up. Recurrent UTIs resolved in all cases. One patient discontinued CIC. Uroflowmetry curves partially normalized in three patients, while two maintained plateau morphology despite marked PVR reduction.
Conclusions:
In this preliminary retrospective case series, hypopressive physiotherapy was associated with substantial reductions in post-void residual volume in this small cohort. These findings from this preliminary case series support further prospective controlled studies.
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