Outpatient Biofeedback Relaxation of the Pelvic Floor in Treating Pediatric Dysfunctional Voiding: A Short-Course Program Is Effective

Abstract

Introduction: We report the treatment results of a short course of biofeedback relaxation of the pelvic floor (BRPF) in treating children with dysfunctional voiding. Materials and Methods: Fourteen girls and 6 boys with videourodynamically proved dysfunctional voiding were enrolled. To increase the awareness of the abnormal voiding pattern, the anatomy of the pelvis and the results of a voiding diary and videourodynamics were extensively explained to the patients/parents. Surface electromyography and uroflowmetry were used as biofeedback tools to teach the adequate relaxation of the pelvic floor during voiding. The child was asked to practice the relaxation technique at home at least twice a day. BRPF was performed once a week until the child had 2 consecutive normal bell-shaped uroflow recordings. Patients were reevaluated at 4, 8, 12 and 24 weeks after BRPF training. Results: The mean patient age was 8.3 ± 3.8 years. The mean number of BRPF training sessions was 2.2 ± 0.9. The mean follow-up period was 18.9 months. Normalization of abnormal uroflowmetry was achieved in 18 patients (90%). The mean maximal uroflow rate and voided volume increased from 13.3 ± 4.3 to 18.0 ± 3.4 ml/s (p < 0.01) and from 138 ± 56 to 193 ± 65 ml (p < 0.01), respectively. The postvoiding residual urine decreased from 54.5 ± 47.6 to 21.3 ± 10.6 ml (p < 0.01). Complete and partial resolution of voiding symptoms was achieved in 14 (70%) and 6 patients (30%), respectively. Recurrence was noted in 2 of the 10 patients who had complete resolution of symptoms and who had been followed up for more than 6 months. Conclusions: Short-course outpatient BRPF is an effective treatment of pediatric dysfunctional voiding.

Voiding school for children with idiopathic urinary incontinence and/or bladder dysfunction

“…Using biofeedback techniques is another possibility, giving a similar outcome [19,20]. The success rate in our setting of VS was after a year about the same (76%), showing that urotherapy in groups of children is a good alternative to individiual urotherapy.…”

Voiding Dysfunction: Another Etiology of Vulvovaginitis in Young Girls

“…This disorder is frequently associated with overactive bladder and the treatment is biofeedback. 3,4 We found that 75% of patients had urinary incontinence data, which is very difficult to obtain because generally the urine leak is unnoticed by the patient or caregiver because the small amount of urine is mixed with the vaginal discharge. As mentioned before, there are patients who have no symptoms and still have altered urodynamics, as was reported in two cases.…”

“…The patient was taught modified voiding habits and how to use BFB once a day at home between each session. 4 All patients were revaluated by a pediatric gynecology after three months. A total or partial remission of inflammatory symptoms and ceased vaginal discharge was considered a positive response.…”

The management of childhood urinary incontinence

“…Treatment of bladder disturbances utilizes EMG tracing of PFM contraction and relaxation visualized in the form of an animation tailored for children, or a simple uroflow curve [56, 57]. Bower et al reported a success rate of 90 % for children with DV who followed a half-day urotherapy program which included uroflow biofeedback and instruction on the relaxation of PFM [58]. Animated biofeedback programs which involve computer games are particularly suitable for children and enable faster resolution of symptoms when compared to non-animated methods [59].…”