title: Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study.
abstract: Fifty-six patients 5.9-15.2 years old with dysfunctional elimination syndrome (DES) unimproved by previous therapies were randomly distributed into two voiding training programs: group 1 contained 26 patients submitted to 24 training sessions over a 3-month period; group 2 contained 30 patients submitted to 16 sessions over a 2-month period. Both groups adhered to a voiding and drinking schedule, received instruction on adequate toilet posture, were reinforced through the maintenance of voiding diaries, and went through proprioceptive and pelvic floor muscle training (Kegel exercises). Group 2 patients also received biofeedback therapy. Clinical evaluation was carried out before each program's initiation and 1, 6, and 12 months after each program's termination. All patients were submitted to renal ultrasonography and dynamic ultrasonography before and 6 months after each program's conclusion. Millivoltage recordings of pelvic floor muscles were compared before and after training. Urinary continence was improved after completion of either training program. Only those patients who received biofeedback training showed a significant decrease in postvoiding residual (PVR) urine as detected by dynamic ultrasonography. Our results show that either training regime can reduce episodic urinary incontinence and urinary tract infection but that further study is required to identify the optimal training duration.
authors.affiliation: Pediatric Nephrourology Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil. monicavascon@ig.com.br
authors.forename: Mônica
authors.initials: M
authors.lastname: Vasconcelos
authors.forename: Eleonora
authors.initials: E
authors.lastname: Lima
authors.forename: Letícia
authors.initials: L
authors.lastname: Caiafa
authors.forename: Alessandra
authors.initials: A
authors.lastname: Noronha
authors.forename: Renata
authors.initials: R
authors.lastname: Cangussu
authors.forename: Suzely
authors.initials: S
authors.lastname: Gomes
authors.forename: Raquel
authors.initials: R
authors.lastname: Freire
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Filgueiras
authors.forename: Junia
authors.initials: J
authors.lastname: Araújo
authors.forename: Gisele
authors.initials: G
authors.lastname: Magnus
authors.forename: Cláudia
authors.initials: C
authors.lastname: Cunha
authors.forename: Enrico
authors.initials: E
authors.lastname: Colozimo
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000628:therapy; D005081:Exercise Therapy; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D017773:Pelvic Floor / Q000502:physiology*; D014549:Urinary Incontinence / Q000628:therapy*