Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux.
OBJECTIVE
It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children.


METHODS
A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements.


RESULTS
The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%).


CONCLUSIONS
Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.
Kibar
Yusuf
Y
Department of Urology, Gulhane Military Medical Academy School of Medicine, Ankara, Turkey.
Ors
Onder
O
Demir
Erkan
E
Kalman
Suleyman
S
Sakallioglu
Onur
O
Dayanc
Murat
M
D000293:Adolescent; D001676:Biofeedback, Psychology; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D004775:Enuresis; D005260:Female; D006801:Humans; D008297:Male; D009126:Muscle Relaxation; D017773:Pelvic Floor / Q000503:physiopathology; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control; D014555:Urination Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000503:physiopathology / Q000628:therapy*