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A MODIFIED BIOFEEDBACK PROGRAM FOR CHILDREN WITH DETRUSOR-SPHINCTER DYSSYNERGIA: 5-YEAR EXPERIENCE

2001; Lippincott Williams & Wilkins; Volume: 166; Issue: 4 Linguagem: Inglês

10.1016/s0022-5347(05)65812-0

1527-3792

Lily Chin-Peuckert, João L. Pippi Salle,

Congenital gastrointestinal and neural anomalies

No AccessJournal of UrologyPEDIATRIC UROLOGY: Papers Presented at Fall 2000 Meeting of Section on Urology, American Academy of Pediatrics1 Oct 2001A MODIFIED BIOFEEDBACK PROGRAM FOR CHILDREN WITH DETRUSOR-SPHINCTER DYSSYNERGIA: 5-YEAR EXPERIENCE LILY CHIN-PEUCKERT and J.L. PIPPI SALLE LILY CHIN-PEUCKERTLILY CHIN-PEUCKERT More articles by this author and J.L. PIPPI SALLEJ.L. PIPPI SALLE More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65812-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed our 5-year experience with a modified 4 to 6-session biofeedback program combining noninvasive urodynamic approaches with various psychological techniques, including externalizing the voiding problem, empowerment and praise, to treat children with detrusor-sphincter dyssynergia. Materials and Methods: Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. Initially normal and abnormal voiding were explained in a unique way and the children observed relaxation and contraction of the pelvic floor muscles while visualizing the electromyography monitor. The bladders were filled naturally and surface electrodes were placed. Psychological strategies were used to engage and motivate the children to achieve maximal cooperation. The children voided while attempting relaxation and post-void residual urine volume was measured by bladder scan. Special and specific praise was provided for progress and increasing self-esteem. Patients returned monthly to review these concepts and practice voiding. Results: Of 87 children 77 completed the program, including 7 boys and 70 girls 3 to 17 years old (mean age 7.8) who required an average of 4.7 sessions (median 4). Results were achieved within 6 sessions in 82% of cases. Of the 77 children 59 (76%) had recurrent urinary tract infections, 38 (49%) had associated bladder instability, 19 (24%) had vesicoureteral reflux and 44 (58%) had constipation. Subjectively 47 patients (61%) reported pronounced improvement in urinary symptoms, while another 24 (32%) reported moderate improvement after biofeedback training. Objectively 47 children (61%) had normal flow with minimal electromyography activity during voiding and a normal post-void residual urine of less than 20% voided volume (p <0.002). In 28 cases (36%) flow studies improved (p <0.03) but post-void residual urine remained elevated. Vesicoureteral reflux resolved in 9 cases after biofeedback training. This approach was equally successful in children in all age groups. Those with more than a 2-year history of symptoms, poor bladder emptying and severe constipation had only moderate improvement. Conclusions: The modified biofeedback program including appropriate explanations and psychological approaches appeared effective for treating 92% of children with detrusor-sphincter dyssynergia. It is less invasive and requires less time than traditional methods, and patients are more compliant with treatment. References 1 : Urodynamic biofeedback: a new approach to treat vesical sphincter dyssynergia. J Urol1979; 122: 205. Link, Google Scholar 2 : Urodynamic biofeedback: a new therapeutic approach for childhood incontinence/infection (vesical voluntary sphincter dyssynergia). J Urol1982; 128: 1253. Link, Google Scholar 3 : Biofeedback therapy for children with dysfunctional voiding. Urology1998; 52: 312. Google Scholar 4 : Biofeedback successfully cures detrusor-sphincter dyssynergia in pediatric patients. J Urol2000; 163: 1927. 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Link, Google Scholar From the Division of Urology, Montreal Children’s Hospital, Montreal, Canada© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byChase J, Austin P, Hoebeke P and McKenna P (2018) The Management of Dysfunctional Voiding in Children: A Report From the Standardisation Committee of the International Children's Continence SocietyJournal of Urology, VOL. 183, NO. 4, (1296-1302), Online publication date: 1-Apr-2010.Drzewiecki B, Kelly P, Marinaccio B, Borer J, Estrada C, Lee R and Bauer S (2009) Biofeedback Training for Lower Urinary Tract Symptoms: Factors Affecting EfficacyJournal of Urology, VOL. 182, NO. 4S, (2050-2055), Online publication date: 1-Oct-2009.Klijn A, Uiterwaal C, Vijverberg M, Winkler P, Dik P and de Jong T (2018) Home Uroflowmetry Biofeedback in Behavioral Training for Dysfunctional Voiding in School-Age Children: A Randomized Controlled StudyJournal of Urology, VOL. 175, NO. 6, (2263-2268), Online publication date: 1-Jun-2006.Mokhless I, Gaafar S, Fouda K, Shafik M and Assem A (2018) Botulinum A Toxin Urethral Sphincter Injection in Children With Nonneurogenic Neurogenic BladderJournal of Urology, VOL. 176, NO. 4S, (1767-1770), Online publication date: 1-Oct-2006.YAGCI S, KIBAR Y, AKAY O, KILIC S, ERDEMIR F, GOK F and DAYANC M (2018) THE EFFECT OF BIOFEEDBACK TREATMENT ON VOIDING AND URODYNAMIC PARAMETERS IN CHILDREN WITH VOIDING DYSFUNCTIONJournal of Urology, VOL. 174, NO. 5, (1994-1998), Online publication date: 1-Nov-2005.YUCEL S, AKKAYA E, GUNTEKIN E, KUKUL E, AKMAN S, MELIKOGLU M and BAYKARA M (2018) CAN ALPHA-BLOCKER THERAPY BE AN ALTERNATIVE TO BIOFEEDBACK FOR DYSFUNCTIONAL VOIDING AND URINARY RETENTION? A PROSPECTIVE STUDYJournal of Urology, VOL. 174, NO. 4 Part 2, (1612-1615), Online publication date: 1-Oct-2005.NELSON J, COOPER C, BOYT M, HAWTREY C and AUSTIN J (2018) IMPROVED UROFLOW PARAMETERS AND POST-VOID RESIDUAL FOLLOWING BIOFEEDBACK THERAPY IN PEDIATRIC PATIENTS WITH DYSFUNCTIONAL VOIDING DOES NOT CORRESPOND TO OUTCOMEJournal of Urology, VOL. 172, NO. 4 Part 2, (1653-1656), Online publication date: 1-Oct-2004.CAIN M, WU S, AUSTIN P, HERNDON C and RINK R (2018) Alpha Blocker Therapy for Children With Dysfunctional Voiding and Urinary RetentionJournal of Urology, VOL. 170, NO. 4 Part 2, (1514-1517), Online publication date: 1-Oct-2003. Volume 166Issue 4October 2001Page: 1470-1475 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordsataxiabladderelectromyographybiofeedback (psychology)abnormalitiesMetricsAuthor Information LILY CHIN-PEUCKERT More articles by this author J.L. 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