Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, the Netherlands.
Department of Social Medical Affairs, UWV, The Hague, the Netherlands.
J Pediatr Urol. 2019 Oct;15(5):530.e1-530.e8. doi: 10.1016/j.jpurol.2019.09.004. Epub 2019 Sep 10.
If children do not experience satisfactory relief of lower urinary tract dysfunction (LUTD) complaints after standard urotherapy is provided, other treatment options need to be explored. To date, little is known about the clinical value of pelvic floor rehabilitation in the treatment of functional voiding disorders.
Therefore, we compared pelvic floor rehabilitation by biofeedback with anal balloon expulsion (BABE) to intensive urotherapy in the treatment of children with inadequate pelvic floor control and functional LUTD.
A retrospective chart study was conducted on children with functional incontinence and inadequate pelvic floor control. All children referred for both intensive inpatient urotherapy and pelvic floor rehabilitation between 2010 and 2018 were considered for inclusion. A total of 52 patients were eligible with 25 children in the group who received BABE before inpatient urotherapy, and 27 children in the group who received BABE subsequently to urotherapy. Main outcome measurement was treatment success according to International Children's Continence Society criteria measured after treatment rounds and follow-up.
Baseline characteristics demonstrate no major differences between the BABE and control group. There was a significant difference in improvement between BABE and inpatient urotherapy after the first and second round of treatment (round 1: BABE vs urotherapy; 12% vs 70%, respectively, round 2: urotherapy vs BABE; 92% vs 34%, respectively, both P < .001). In both cases, the urotherapy group obtained greater results (Fig. 1). When the additional effect of BABE on urotherapy treatment is assessed, no significant difference is found (P = .355) in the children who received BABE; 30 (58%) showed improvement on pelvic floor control.
Our findings imply that training pelvic floor control in combination with inpatient urotherapy does not influence treatment effectiveness on incontinence. Intensive urotherapy contains biofeedback by real-time uroflowmetry; children receive direct feedback on their voiding behaviour. Attention offered to the child and achieving cognitive maturity with corresponding behaviour is of paramount importance. It is known that combining several kinds of biofeedback does not enhance the outcome. However, our results do not provide a conclusive answer to the effectiveness of pelvic floor physical therapy in the treatment of children with LUTD because we specifically investigated BABE.
In this study, we could not prove that pelvic floor rehabilitation by BABE has an additional effect on inpatient urotherapy on incontinence outcomes. Considering the invasive nature of BABE, the use of BABE to obtain continence should therefore be discouraged.
如果儿童在接受标准尿路治疗后仍未缓解下尿路功能障碍（LUTD）的症状，则需要探索其他治疗方法。迄今为止，对于盆底康复治疗功能性排尿障碍的临床价值知之甚少。
因此，我们比较了生物反馈盆底康复与肛门球囊扩张（BABE）在治疗盆底控制不足和功能性 LUTD 儿童中的疗效。
对 2010 年至 2018 年间因功能失禁和盆底控制不足而接受强化住院尿路治疗和盆底康复的儿童进行回顾性图表研究。所有符合条件的儿童均接受了 BABE 治疗，其中 25 名儿童在接受住院尿路治疗前接受了 BABE 治疗，27 名儿童在接受住院尿路治疗后接受了 BABE 治疗。主要疗效评估标准为根据国际儿童尿控协会标准在治疗结束和随访时测量的治疗成功率。
BABE 组和对照组的基线特征无明显差异。在第一轮和第二轮治疗后，BABE 组和住院尿路治疗组之间的改善程度存在显著差异（第一轮：BABE 组与尿路治疗组，分别为 12%和 70%；第二轮：尿路治疗组与 BABE 组，分别为 92%和 34%，均 P<0.001）。在这两种情况下，尿路治疗组的结果都更好（图 1）。当评估 BABE 对尿路治疗的额外影响时，接受 BABE 治疗的儿童中没有发现显著差异（P=0.355），30 名（58%）儿童的盆底控制得到改善。
我们的研究结果表明，在住院尿路治疗的基础上联合进行盆底控制训练不会影响对失禁的治疗效果。强化尿路治疗包含实时尿流率的生物反馈；儿童可以直接了解自己的排尿行为。关注儿童并通过相应行为实现认知成熟至关重要。已知结合多种生物反馈并不会提高疗效。然而，我们的研究结果并没有为盆底物理治疗治疗 LUTD 儿童的有效性提供明确的答案，因为我们专门研究了 BABE。
在这项研究中，我们无法证明生物反馈盆底康复通过 BABE 对住院尿路治疗的失禁疗效有额外的作用。考虑到 BABE 的侵入性，应避免使用 BABE 来获得控制。
