Abstract
To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years. 72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns. BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DVI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients. Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, while presence of nocturnal enuresis may be a negative predictor of the training effect.
Highlights
Lower urinary tract dysfunction (LUTD) includes a wide spectrum of voiding dysfunction in the absence of neurological, structural, or medical causes [1]
Dimercaptosuccinic acid (DMSA) scan was done in 51 patient demonstrating renal scarring in 72.5%, while ve
We evaluated the success of a combination of standard and biofeedback bladder control training (BCT) in 72 girls with various dysfunctional elimination syndrome and/or recurrent urinary tract infections (UTI)
Summary
Lower urinary tract dysfunction (LUTD) includes a wide spectrum of voiding dysfunction in the absence of neurological, structural, or medical causes [1]. It is certain that anatomically close relationship of bladder, urethra and rectum and pelvic floor muscles, as well as similar inervation (S2-S4) of urethral and anal sphincters are predisposing factors for lower urinary tract and bowel dysfunctions to occur simultaneously. It has been suggested and already accepted that bladder instability and bowel dysfunction may lead to over-training of pelvic floor, resulting in a high tone of pelvic floor muscles, which can cause functional outlet obstruction [7]. McKenna et al suggested that pathophysiology of pelvic floor dysfunction might be related to a phenomenon known as “neuroplasticity”. It is very important to recognize and treat DES as early as possible
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