Chin-Peuckert L, Salle J L
Division of Urology, Montreal Children's Hospital, Montreal, Canada.
J Urol. 2001 Oct;166(4):1470-5.
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.
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.
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.
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.
我们回顾了一项为期5年的经验，该经验涉及一种改良的4至6节生物反馈程序，该程序将非侵入性尿动力学方法与各种心理技术相结合，包括将排尿问题外化、给予自主权和赞扬，以治疗逼尿肌-括约肌协同失调的儿童。
使用尿动力学处理器进行生物反馈，该处理器能够同时记录尿流和肌电图，并直观显示尿流/肌电图活动。最初，以独特的方式解释正常和异常排尿情况，让儿童在观察肌电图监测器的同时，观察盆底肌肉的放松和收缩。膀胱自然充盈后放置表面电极。运用心理策略促使儿童积极配合并激发其积极性。儿童在尝试放松的同时排尿，并用膀胱扫描仪测量排尿后残余尿量。对取得的进展和自尊心的增强给予特别且具体的赞扬。患者每月复诊，复习这些概念并练习排尿。
87名儿童中，77名完成了该程序，其中包括7名男孩和70名女孩，年龄在3至17岁之间（平均年龄7.8岁），平均需要4.7节课程（中位数为4节）。82%的病例在6节课程内取得了效果。77名儿童中，59名（76%）有复发性尿路感染，38名（49%）伴有膀胱不稳定，19名（24%）有膀胱输尿管反流，44名（58%）有便秘。主观上，47名患者（61%）报告排尿症状有明显改善，另有24名（32%）报告在生物反馈训练后有中度改善。客观上，47名儿童（61%）排尿时尿流正常，肌电图活动最小，排尿后残余尿量正常，小于排尿量的20%（p<0.002）。28例（36%）尿流研究有所改善（p<0.03），但排尿后残余尿量仍升高。生物反馈训练后，9例膀胱输尿管反流得到缓解。这种方法在所有年龄组的儿童中同样成功。有超过2年症状史、膀胱排空不良和严重便秘的儿童只有中度改善。
包括适当解释和心理方法的改良生物反馈程序似乎对治疗92%的逼尿肌-括约肌协同失调儿童有效。它比传统方法侵入性更小，所需时间更少，且患者对治疗的依从性更高。
