Bladder Biofeedback Research Articles

BIOFEEDBACK TRAINING FOR DETRUSOR OVERACTIVITY IN CHILDREN

We evaluated biofeedback training for incontinence due to detrusor overactivity in children. Included in our study were 22 boys and 17 girls with a mean age of 11.2 years. We noted nighttime incontinence in 3 patients, nighttime incontinence and daytime urinary symptoms in 26, and daytime incontinence in 10. All patients had detrusor overactivity and incontinence refractory to conventional treatment, including bladder training, tricyclic antidepressants, anticholinergics, desmopressin and/or conditioning therapy. Urodynamic study was performed using an 8Fr double lumen transurethral catheter for cystometry, a double balloon transrectal catheter for rectal pressure and external anal sphincter pressure measurement, and surface electrodes for sphincter electromyography. During biofeedback training patients were instructed to contract the anal sphincter without raising abdominal pressure to inhibit overactive bladder contractions. Biofeedback training was repeated monthly until cystometry revealed a stable bladder or lower urinary tract symptoms improved considerably. Four patients were lost to followup. Of the remaining 35 children urinary symptoms were cured in 23 and improved in 4. Urodynamic studies after 6 months of biofeedback training in 33 cases showed that bladder overactivity disappeared in 10 and improved in 18. Bladder capacity at the initial desire to void and maximum cystometric capacity increased significantly (p = 0.0115 and <0.0001, respectively). Detrusor-sphincter dyssynergia in 2 patients before biofeedback training resolved in each after therapy. Biofeedback training for detrusor overactivity is effective even in pediatric cases refractory to conventional treatment.

BIOFEEDBACK SUCCESSFULLY CURES DETRUSOR-SPHINCTER DYSSYNERGIA IN PEDIATRIC PATIENTS

We assessed the efficacy of voiding and bladder biofeedback for achieving perineal synergy and curing symptoms in children with detrusor-sphincter dyssynergia A total of 16 boys and 27 girls 4 to 14 years old with detrusor-sphincter dyssynergia diagnosed by uroflowmetry and electromyography underwent biweekly voiding biofeedback therapy consisting of perineal floor electromyography during uroflowmetry. The 6 patients with enuresis and an unstable bladder also underwent bladder biofeedback training during cystometry. Biofeedback continued until detrusor-sphincter dyssynergia resolved. Followup consisted of electromyography and uroflowmetry 1 month after completing biofeedback training, and telephone interviews after 2 and 4 years. Biofeedback resolved detrusor-sphincter dyssynergia in all children, although the condition disappeared significantly sooner in girls (p <0.02). Secondary enuresis disappeared significantly earlier than primary enuresis (p <0.0001). The 2-year success rate of 87.18% for enuresis decreased to 80% at the 4-year followup. Voiding and bladder biofeedback achieves perineal synergy and cures symptoms in children with detrusor-sphincter dyssynergia

The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity: L. Hoekx, J.J. Wyndaele, and A. Vermandel. J Urol 160:858–860, (September), 1998

The role of bladder biofeedback in the treatment of children with refractory nocturnal enuresis associated with idiopathic detrusor instability and small bladder capacity: L. Hoekx, J.J. Wyndaele, and A. Vermandel. J Urol 160:858–860, (September), 1998

THE ROLE OF BLADDER BIOFEEDBACK IN THE TREATMENT OF CHILDREN WITH REFRACTORY NOCTURNAL ENURESIS ASSOCIATED WITH IDIOPATHIC DETRUSOR INSTABILITY AND SMALL BLADDER CAPACITY

Purpose Not all children with primary nocturnal enuresis, an unstable detrusor and small bladder capacity can be treated successfully with anticholinergics and bladder drill. We report our use of bladder biofeedback in patients who did not respond to 3 months of such treatment. Materials and Methods A total of 24 patients (median age 10.4 years) were studied. For bladder biofeedback a transurethral catheter was placed and connected with a 3-way connector. The bladder was slowly filled through this catheter and the intravesical pressure could be seen on a vertical tube, which was also connected to the transurethral catheter. The perineal bulbar detrusor inhibiting reflex was used in cases of involuntary bladder contraction. During the day patients retained urine as long as possible and completed a micturition chart. Results Of the 24 patients bed-wetting stopped completely in 17 and decreased in 6, and treatment failed in 1. All patients were followed for at least 6 months after treatment. There were 2 cases of recurrence in the group that was cured. Conclusions Intravesical biofeedback can successfully treat patients with refractory primary enuresis associated with unstable detrusor and small bladder capacity.

Bladder Biofeedback for the Treatment of Refractory Sensory Urgency in Adults

Evaluation of bladder biofeedback in patients with sensory urgency refractory to medication and classical bladder training. In 12 such patients a non-electronic technique of bladder biofeedback was used. Ambulatory treatment sessions were done once a week for 4 weeks, as opposed to every 14 days, with a mean total treatment period of 8 weeks. Micturition charts were completed before, during and 14 days after treatment by the patient. Before starting, patients had a mean of 15.8 micturitions/day, 2.3 micturitions/night, and a mean functional bladder capacity of 96 ml (26-172 ml). Urodynamic investigation showed a low-capacity bladder, hypersensitivity in some patients, and normal urodynamic parameters in others. At the end of biofeedback, patients had a mean of 5.7 micturitions/day, 0.3 micturitions/night, and a mean functional bladder capacity of 296 ml (163-470 ml). The results 9 months after completing the treatment were unchanged. Quality of life improved substantially in all. Bladder biofeedback is a valuable treatment for sensory urgency refractory to classical treatment.