The effect of biofeedback treatment for children with non‐neurogenic voiding dysfunction: A systematic review and meta‐analysis

Abstract

Background Children's non‐neurogenic voiding dysfunction (NVD) is a syndrome characterized by lower urinary tract symptoms (LUTs) because of the inability to relax the external sphincter. Patients with NVD always suffer from urinary tract infections (UTI), incontinence, constipation. The aim of this study is to assess the efficacy of biofeedback treatment for children's NVD. Methods PubMed, Embase, Cochrane library database were searched for all relevant studies. Two independent reviewers decided whether to include the study, conducted quality evaluation, and extracted article data. A random‐effects model was used to calculate overall effect sizes. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) served as the summary statistics for meta‐analysis. And sensitivity analysis was subsequently performed. Results Fifteen studies and 1274 patients were included in the systemic review, seven RCTs and 539 patients were included in meta‐analysis. Meta‐analysis showed efficacy of biofeedback treatment in following aspects, (1) relieving UTI (RR: 1.71, 95% CI: 1.11 to 2.64), (2) reducing PVR (MD: 9.51, 95% CI: 2.03 to 16.98), (3) increasing maximum urine flow rate (MD: 4.28, 95% CI: 2.14 to 6.42) and average urine flow rate (MD: 1.49, 95% CI: 0.53 to 2.46), (4) relieving constipation (RR: 1.59, 95% CI: 1.12 to 2.26)，(5) improving abnormal voiding pattern (RR: 1.75, 95% CI: 1.30 to 2.36) and abnormal EMG during voiding (RR: 1.55, 95% CI: 1.25 to 1.91). The improvement of UTI symptoms, maximum urine flow rate and average urine flow rate took a longer time (12 months). In terms of daytime incontinence (RR: 1.20, 95% CI [0.96, 1.50], p = 0.11), nighttime incontinence (RR: 1.20, 95% CI [0.62, 2.32], p = 0.58), no significant difference was found between biofeedback treatment and standard urotherapy. The qualitative analysis showed that biofeedback treatment was beneficial for NVD. Conclusion Compared with standard urotherapy, biofeedback treatment is effective for some symptoms, such as UTI and constipation, and can improve some uroflowmetric parameters, such as PVR. Biofeedback treatment seems to have a better long‐term effect.

Long-Term Follow-Up of Lower Urinary Tract Outcome in Children with Dysfunctional Voiding

“…Combined pharmacotherapy and standard urotherapy might be necessary for children with more severe DV and those with incontinence episodes [18]. Biofeedback-based PFMT has been recommended as the best noninvasive treatment for children with DV among the various available treatment approaches [1,6,19].…”

“…Dysfunctional voiding (DV) in children may result in lower urinary tract symptoms (LUTS), such as urgency, frequency, urinary incontinence, and difficulty in urination. High post-void residual (PVR) urine volume, vesicoureteral reflux (VUR), and recurrent urinary tract infection (UTI) may develop in children with severe DV, which can lead to renal function deterioration in the absence of appropriate treatment [1]. Detrusor overactivity (DO) is the most common urodynamic finding in children with DV, including high voiding detrusor pressure, recurrent UTI, bilateral VUR, and bowel dysfunction [2].…”

Updates of Overactive Bladder in Pediatrics

“…A recent systematic review revealed that biofeedback is effective in alleviating UTI symptoms or constipation. Moreover, biofeedback can improve postvoid residual and electromyography during voiding and has a longer-term effect [ 46 ].…”