Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
J Urol. 2011 Dec;186(6):2379-84. doi: 10.1016/j.juro.2011.07.118. Epub 2011 Oct 22.
Animated biofeedback is an established treatment for pediatric dysfunctional voiding. Bowel dysfunction is closely associated with dysfunctional voiding. We evaluated the efficacy of animated biofeedback urotherapy in bowel and voiding dysfunction in children with dysfunctional elimination syndrome.
A total of 80 children with dysfunctional elimination syndrome were randomly assigned to undergo animated biofeedback (group A, 40 patients) or conservative therapy (group B, 40 patients). Group A underwent animated biofeedback along with pelvic floor muscle exercises and behavioral modification (hydration, high fiber diet, scheduled voiding). Group B underwent behavioral modification only. Dysfunctional voiding symptom score, constipation and fecal soiling episodes per week (according to Paris Consensus on Childhood Constipation Terminology criteria), and uroflowmetry parameters were evaluated before and 6 and 12 months after treatment in both groups.
Subjective and objective voiding problems were significantly improved. Vesicoureteral reflux resolved in 7 of 9 children (78%) and urinary tract infection did not recur in 10 of 14 children (71%) within 1 year. Bladder capacity and voided volume did not significantly improve. Post-void residual and voiding time decreased considerably, while maximum and average urine flow increased significantly. All children with fecal soiling and 17 of 25 with constipation (68%) in group A were symptom-free within 1 year after treatment. Animated biofeedback therapy was more efficient than nonbiofeedback management regarding objective and subjective voiding problems and bowel dysfunction (p <0.05).
Animated biofeedback effectively treats bowel and voiding dysfunction in children with dysfunctional voiding. Pelvic floor muscle exercises coordinate breathing and pelvic floor muscle contractions, and are beneficial in improving bowel dysfunction.
动画生物反馈是治疗小儿功能障碍性排尿的一种既定方法。肠道功能障碍与排尿功能障碍密切相关。我们评估了动画生物反馈尿动力学疗法在功能性排泄综合征儿童的肠道和排尿功能障碍中的疗效。
共有 80 例功能性排泄综合征患儿被随机分为动画生物反馈组（A 组，40 例）和保守治疗组（B 组，40 例）。A 组接受动画生物反馈治疗，同时进行盆底肌锻炼和行为矫正（补液、高纤维饮食、定时排尿）。B 组仅进行行为矫正。两组患者分别于治疗前、治疗后 6 个月和 12 个月评估功能性排尿症状评分、每周便秘和粪便污染次数（根据巴黎儿童便秘共识术语标准）和尿流动力学参数。
主观和客观排尿问题明显改善。9 例中有 7 例（78%）的肾盂输尿管反流得到解决，14 例中有 10 例（71%）的尿路感染在 1 年内未再复发。膀胱容量和排尿量无明显改善。残余尿量和排尿时间明显减少，最大和平均尿流显著增加。A 组所有粪便污染患儿和 25 例便秘患儿中的 17 例（68%）在治疗后 1 年内症状消失。动画生物反馈治疗在客观和主观排尿问题以及肠道功能障碍方面比非生物反馈管理更有效（p<0.05）。
动画生物反馈可有效治疗功能性排尿患儿的肠道和排尿功能障碍。盆底肌锻炼协调呼吸和盆底肌收缩，有利于改善肠道功能障碍。
