Medical School of University of Belgrade, Belgrade, Serbia.
Int Braz J Urol. 2013 Jan-Feb;39(1):118-26; discussion 127. doi: 10.1590/S1677-5538.IBJU.2013.01.15.
To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years.
72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns.
BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DVI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients.
Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, while presence of nocturnal enuresis may be a negative predictor of the training effect.
评估标准和生物反馈膀胱控制训练（BCT）对功能性排尿障碍综合征（主要结局）的疗效，以及对减少尿路感染（UTI）和减少抗菌预防药物的使用的影响，以及/或抗胆碱能/α-阻滞剂（次要结局）在年龄大于 5 岁的女孩中。
72 名女孩，中位年龄 8 岁（四分位距，IQR 7-10），接受标准 BCT（认知、行为和便秘治疗）和 12 个小时的动画生物反馈，使用互动电脑游戏在 8 周内完成。50 例患者在中位 11 个月（IQR，6-17）后进行重新评估。BCT 的有效性通过降低功能障碍性排空评分（DVS）、白天尿失禁（DUI）、便秘、UTI、夜间遗尿（NE）、残余尿量（PVR）以及改善膀胱容量和尿流/肌电图模式来确定。
BCT 显著改善了 DUI、NE、便秘、膀胱容量、尿流/肌电图，而 PVR 的减少未达到统计学意义。此外，UTI、抗菌预防和医学尿路治疗的发生率显著降低。在 BCT 结束时和重新评估时，DVS、DVI、NE、膀胱容量和排尿模式没有显著差异。63.9%的患者对治疗反应有家长感知，15.3%的患者有完全反应，这支持了 BCT 的成功。
标准和生物反馈 BCT 的联合应用改善了功能性排尿障碍综合征，并减少了 UTI，同时停止了抗菌预防药物的使用，/或抗胆碱能/α-阻滞剂在大多数患者中。对于膀胱壁厚度较高的患者以及伴有膀胱输尿管反流的患者，预计会有更好的训练效果，而夜间遗尿的存在可能是训练效果的负预测因素。
