Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 62, Dr. Qarib St, Keshavarz Blvd, 4194 33151, Tehran, Iran.
Department of Physical Therapy, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Appl Psychophysiol Biofeedback. 2020 Dec;45(4):259-266. doi: 10.1007/s10484-020-09474-z.
We assessed efficacy of biofeedback therapy and home pelvic floor muscle exercises in children with dysfunctional voiding (DV) associated with mild to moderate hydronephrosis. This prospective study comprised fifty seven children (21 boys, 36 girls; mean age 8.9 ± 2.6) with DV and mild to moderate hydronephrosis. Children were randomly allocated into two treatment groups including control group who underwent standard urotherapy and case group who received biofeedback therapy in addition to standard urotherapy. A 99mTc diethylenetriamine pentaacetic acid (99mDTPA) scan, voiding cystoureterography, kidney and bladder ultrasounds, voiding diary and uroflowmetry with electromyography (EMG) were performed in all study participants at the baseline. Children with evidence of complete obstruction in DTPA scan and vesicoureteral reflux were excluded from enrollment. A complete voiding diary, kidney and bladder ultrasounds and uroflowmetry/EMG were also performed 6 months and 1 year after completion of the treatment. We noted a more significant decline in anteroposterior pelvic diameter in case group compared to control group (P < 0.05). The mean maximal urine flow rate prior to treatment was 16.5 ± 2.6 and 16.1 ± 3 ml/s in case and control groups, respectively. This finding increased significantly 1 year after the treatment in case group compared to controls (25 ± 7.2 ml/s vs. 18.4 ± 5.9 ml/s, respectively; P < 0.001). Improvement of various parameters in voiding diary was also more significant in the case group. Biofeedback therapy can effectively resolve non-refluxing and non-obstructive hydronephrosis in children with DV.
我们评估了生物反馈疗法和家庭骨盆底肌肉锻炼对伴有轻至中度肾积水的功能性排尿障碍（DV）儿童的疗效。这项前瞻性研究包括 57 名儿童（21 名男孩，36 名女孩；平均年龄 8.9±2.6 岁），他们患有 DV 和轻至中度肾积水。儿童被随机分配到两个治疗组，包括接受标准尿路治疗的对照组和接受生物反馈治疗加标准尿路治疗的病例组。所有研究参与者在基线时均进行 99mTc 二乙三胺五乙酸（99mDTPA）扫描、排尿性膀胱尿道造影、肾脏和膀胱超声、排尿日记和尿流率肌电图（EMG）检查。在 DTPA 扫描中发现完全梗阻和膀胱输尿管反流的儿童被排除在入组之外。在治疗完成后 6 个月和 1 年后，还进行了完整的排尿日记、肾脏和膀胱超声以及尿流率/EMG 检查。与对照组相比，病例组的骨盆前后径有更显著的下降（P<0.05）。治疗前平均最大尿流率在病例组和对照组分别为 16.5±2.6 和 16.1±3ml/s，治疗 1 年后病例组明显增加，而对照组则下降（分别为 25±7.2ml/s和 18.4±5.9ml/s，P<0.001）。病例组在排尿日记中的各种参数的改善也更为显著。生物反馈治疗可以有效地解决儿童伴有 DV 的非反流性和非梗阻性肾积水。
