title: Bladder control training in girls with lower urinary tract dysfunction.
abstract: OBJECTIVE
  To evaluate the efficacy of standard and biofeedback bladder control training (BCT) on the resolution of dysfunctional elimination syndrome (primary outcome), and on the reduction of urinary tract infections (UTI) and the use of medications such as antibacterial prophylaxis and/or anticholinergic/alpha-blockers (secondary outcome) in girls older than aged least 5 years.
  
  
  METHODS
  72 girls, median age of 8 years (interquartile range, IQR 7-10) were subjected to standard BCT (cognitive, behavioural and constipation treatment) and 12 one-hour sessions of animated biofeedback using interactive computer games within 8 weeks. Fifty patients were reevaluated after median 11 (IQR, 6-17) months. Effectiveness of BCT was determined by reduction of dysfunctional voiding score (DVS), daytime urinary incontinence (DUI), constipation, UTI, nocturnal enuresis (NE), post void residual (PVR), and improvements in bladder capacity and uroflow/EMG patterns.
  
  
  RESULTS
  BCT resulted in significant normalization of DUI, NE, constipation, bladder capacity, uroflow/EMG, while decrease of PVR didn't reach statistical significance. In addition, the incidence of UTI, antibacterial prophylaxis and medical urotherapy significantly decreased. There were no significant differences in DVS, DVI, NE, bladder capacity and voiding pattern at the end of the BCT and at the time of reevaluation. The success on BCT was supported by parenteral perception of the treatment response in 63.9% and full response in additional 15.3% of the patients.
  
  
  CONCLUSIONS
  Combination of standard and biofeedback BCT improved dysfunctional elimination syndrome and decreased UTI with discontinuation of antibacterial prophylaxis and/or anticholinergic/alpha-blockers in the majority of the patients. Better training results are expected in patients with higher bladder wall thickness as well as in those with vesicoureteral reflux, while presence of nocturnal enuresis may be a negative predictor of the training effect.
authors.affiliation: Medical School of University of Belgrade, Belgrade, Serbia. amirapecoantic@yahoo.com
authors.forename: Peco-Antić
authors.initials: PA
authors.lastname: Amira
authors.forename: Paripović
authors.initials: P
authors.lastname: Dušan
authors.forename: Miloševski-Lomić
authors.initials: ML
authors.lastname: Gordana
authors.forename: Trojanović
authors.initials: T
authors.lastname: Sandra
authors.forename: Ivana
authors.initials: I
authors.lastname: Ivaniševic
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D002648:Child; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000503:physiopathology / Q000628:therapy*; D017773:Pelvic Floor; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000503:physiopathology / Q000628:therapy*
chemical_list: D000317:Adrenergic alpha-Antagonists; D000892:Anti-Infective Agents, Urinary; D018680:Cholinergic Antagonists