Biofeedback Therapy for Dysfunctional Voiding in Children

Abstract

The past decade has seen a dramatic shift in the management of lower urinary tract dysfunction, including dysfunctional voiding, in children. Once treated primarily with medication, dysfunctional voiding now is managed successfully in most cases with noninvasive evaluations and biofeedback-based pelvic floor muscle retraining. Introduced in 1979, biofeedback initially was expensive and labor intensive, requiring inpatient treatment. The use of animated computer games has expedited results, allowing excellent resolution of dysfunctional voiding and coexisting conditions such as vesicoureteral reflux and constipation with outpatient treatment. Morbidity from medications and surgical procedures has been reduced at centers using biofeedback. Future goals of biofeedback therapy should include further refinements in technique and increasing access to care.

Re: Thom M, Campigotto M, Vemulakonda V, Coplen D, Austin PF. Management of lower urinary tract dysfunction: A stepwise approach. J Pediatr Urol 2011;8:20–24.

“…We get the impression that alpha blockers have been overused by the researchers in the current series, and they are confronted with the questions of how to end this medication, and whether a permanent cure can be obtained with its use. On the other hand, biofeedback appears not to have been an alternative for the authors, although a successful outcome with biofeedback has been reported [2]. Perhaps, 'physical therapy' in the article needs elaboration.…”

ICS Educational Module: Electromyography in the assessment and therapy of lower urinary tract dysfunction in adults

“…On the other hand, in dysfunctional voiders, EMG biofeedback is used as a tool to help relax the pelvic floor muscles during micturition. While being a well established method in the treatment of voiding dysfunctions in the pediatric population, where combination of acoustic and visual biofeedback plays an important role, evidence in adults is lacking …”

Lower Urinary Tract Dysfunction: A Childhood Problem in Adults?

“…The primary goal of biofeedback therapy is to identify a specific biological pattern and develop voluntary control techniques to moderate the pattern [34]. In considering the pathology of LUT dysfunction in a neuroplastic model, biofeedback therapy addresses multiple components, including the central nervous system, peripheral nerves, and pelvic floor musculature [35]. It is a labor-intensive process for both caregiver and patient, but with newer technology and animated therapy, efficacy has been as high as 84-95% for daytime incontinence [36,37].…”