The effect of Biofeedback treatment on voiding and Urodynamic Parameters in Children with voiding Dysfunction

Abstract

PURPOSE We studied the effects of biofeedback treatment on voiding and urodynamic parameters in children with voiding dysfunction. MATERIAL AND METHODS We prospectively studied 395 children between June 1998 and September 2007. Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. At the beginning of the study this treatment was performed once weekly. After patients understood the concept and performed homework regularly sessions were scheduled at 3 to 4-week intervals and continued for 6 months. All children were evaluated at 6 months and again at 2 years after completing biofeedback training. RESULTS The number of the children completing biofeedback was 352 (89.1%). Improvement was obtained in all parameters, ranging from 59.6% to 84.9% at 6 months. Maximum improvement was acquired with staccato voiding in 203 of 239 children (84.9%), whereas the least improvement was acquired with daytime wetting in 114 of 191 children (59.6%). These improvements continued at 2-year followup, and ranged from 53.6% to 87.2%. While the rate of improvement for nocturnal enuresis, staccato voiding, detrusor-sphincter dyssynergia, vesicoureteral reflux and urinary tract infection had increased, the remaining parameters had decreased at 2-year followup. CONCLUSIONS Biofeedback training is a simple, effective and well tolerated treatment modality in children for various parameters resulting from bladder dysfunction. Motivation and willingness to participate in biofeedback treatment are important selection criteria.