Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
J Pediatr Urol. 2021 Dec;17(6):793.e1-793.e6. doi: 10.1016/j.jpurol.2021.09.022. Epub 2021 Sep 25.
Dysfunctional voiding (DV) in children is a common issue, which can be found in up to 30% of children with wetting problems. Biofeedback assisted pelvic floor muscle training (PFMT) is an established nonpharmacological method to treat DV. The aim of the present study was to evaluate the efficacy of physiotherapeutic intervention with biofeedback assisted PFMT in children with DV.
Children referred with DV, unresponsive to standard urotherapy were included in this study. All children underwent biofeedback assisted PFMT sessions with a physiotherapist. Uroflowmetries and measurements of post-void residual (PVR) urine were performed before and after the treatment, and the following parameters were registered; daytime incontinence (DI), nocturnal enuresis (NE), constipation, faecal incontinence (FI), and recurrent urinary tract infections (UTI). Other concomitant treatments were noted. The primary outcomes were the resolution of DV evaluated by uroflow curve configuration and PVR. Secondary outcomes were the resolution of DI, NE and the reduction of recurrent UTIs.
Forty-six children (mean age 9.6 ± 2.4 years, 38 girls) were included in the analysis. The median period of treatment was 9.0 ± 8.5 months (2-9 visits). Twenty-seven (59%) children responded to treatment according to one or both primary outcomes; uroflow configuration (50%) and PVR (28%). DI resolved in 12 (26%) children and 27 of the 32 children, who prior to the treatment had recurrent UTIs experienced no UTIs during the follow up period. The use of anticholinergics was a significant negative predictor for response to treatment. We found that almost half of the responders (48%) reached effect prior to the fourth visit.
Biofeedback assisted PFMT can improve the symptoms in children with DV. When comparing to existing literature we find a less pronounced effect of the intervention. A possible explanation may be that the children enrolled in this study were recruited from a tertiary referral centre and were all refractory to standard urotherapy. Moreover, the difference in patient characteristics and treatment protocols between different studies make direct comparisons of efficacy difficult.
Physiotherapeutic intervention with biofeedback assisted PFMT seems to lead to better uroflow patterns in approximately 60% of cases in DV improving the uroflow curves and PVR, however improvement in uroflowmetry patterns is not necessarily reflected in the resolution of incontinence or UT symptoms. The use of anticholinergics seems to be a negative predictor for response to treatment.
儿童排尿功能障碍（DV）是一种常见问题，多达 30%的遗尿儿童存在这种问题。生物反馈辅助盆底肌训练（PFMT）是一种已确立的非药物治疗 DV 的方法。本研究旨在评估生物反馈辅助 PFMT 对 DV 儿童的治疗效果。
本研究纳入了对标准尿路治疗无反应的 DV 儿童。所有儿童均由物理治疗师进行生物反馈辅助 PFMT 治疗。在治疗前后进行尿流率测量和残余尿量（PVR）测量，并记录以下参数：日间尿失禁（DI）、夜间遗尿（NE）、便秘、粪便失禁（FI）和复发性尿路感染（UTI）。记录其他伴随治疗。主要结局是通过尿流曲线形态和 PVR 评估 DV 的缓解。次要结局是 DI、NE 的缓解和复发性 UTI 的减少。
46 名儿童（平均年龄 9.6±2.4 岁，38 名女孩）纳入分析。中位治疗时间为 9.0±8.5 个月（2-9 次就诊）。根据一项或两项主要结局，27 名（59%）儿童对治疗有反应；尿流曲线形态（50%）和 PVR（28%）。12 名（26%）儿童的 DI 得到缓解，32 名在治疗前有复发性 UTI 的儿童在随访期间没有 UTI。抗胆碱能药物的使用是治疗反应的显著负预测因素。我们发现，近一半的反应者（48%）在第四次就诊前就达到了效果。
生物反馈辅助 PFMT 可改善 DV 儿童的症状。与现有文献相比，我们发现干预的效果不太明显。一种可能的解释是，本研究纳入的儿童均来自三级转诊中心，且均对标准尿路治疗无反应。此外，不同研究之间的患者特征和治疗方案的差异使得疗效的直接比较变得困难。
生物反馈辅助 PFMT 的物理治疗干预似乎可使大约 60%的 DV 病例的尿流模式得到改善，从而改善尿流曲线和 PVR，但尿流模式的改善并不一定反映在尿失禁或 UTI 症状的缓解上。抗胆碱能药物的使用似乎是治疗反应的负预测因素。
