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Urodynamic biofeedback training for children with bladder-sphincter dyscoordination during voiding
D Kjølseth1, L M Knudsen, B Madsen
1Urological Department K, Aarhus Municipal Hospital, Denmark.
Insights
Biofeedback therapy effectively treats staccato voiding in children, with most experiencing symptom relief or cure. Benefits are maintained long-term, with relapses managed by refresher courses.
Area of Science:
- Pediatric Urology
- Urodynamics
- Pelvic Floor Dysfunction
Background:
- Recurrent urinary tract infections (UTIs), wetting, and voiding dysfunction in children can stem from pelvic floor contractions causing staccato voiding.
- Urodynamic evaluation is crucial for diagnosing overactive urethra during voiding in pediatric patients.
Purpose of the Study:
- To assess the immediate and long-term effectiveness of non-invasive urodynamic biofeedback (BF) therapy for staccato voiding in children.
- To determine if improvements in voiding dysfunction are sustained over time and to evaluate relapse rates.
Main Methods:
- A historical follow-up study involving 31 neurologically normal children (aged 5-15 years) with urodynamically proven overactive urethra during voiding.
- Biofeedback (BF) therapy was administered, and outcomes were assessed immediately and during a long-term follow-up (mean 4 years).
Main Results:
- Twenty-four children (77.5%) benefited, with 16 (51.5%) cured and 8 (26%) showing significant symptom reduction.
- Urinary flow normalized or nearly normalized in 77.5% of patients, though no correlation existed between subjective/objective improvements or initial urodynamic findings and outcome.
- Long-term follow-up showed sustained benefits, with low relapse rates managed effectively by refresher courses.
Conclusions:
- Urodynamic biofeedback (BF) is an effective treatment for staccato voiding and related voiding dysfunctions in children.
- The positive effects of biofeedback therapy are largely maintained in the long term, with relapses being manageable.
Abstract:
Neurologically normal children with recurrent urinary tract infections (UTIs), night- and daytime wetting, and urge and painful voiding may have staccato voiding due to pelvic floor contractions. The immediate effect of non-invasive urodynamic biofeedback (BF) therapy was assessed using a historical follow-up study in 31 children aged 5-15 years suffering from urodynamically proven overactive urethra during voiding. A long-term follow-up study was performed to investigate whether improvement was maintained. Twenty-four children (77.5%) benefited from the treatment. Of these 16 (51.5%) were cured, while 8 (26%) had a pronounced reduction in their symptoms. Although the flow was normalized in 17 (55%) and nearly normalized in 7 (22.5%), there was no significant correlation between subjective and objective criteria of improvement. Similarly, no relationship was found between the initial urodynamic characteristics and the treatment outcome. During a mean follow-up time of 4 years (range: 1-7.5 years) two of the initially cured patients relapsed. They were recurred with a refresher course. Three had had a single or a few episodes of cystitis in the course of several years. Of the patients with pronounced reduction in their symptoms, three relapsed. A refresher course was attempted in two patients; one was successful. It can thus be concluded that BF is an effective way of treating this disturbance and the beneficial effect is to a wide degree maintained.