title: Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Biofeedback has been used to treat children with symptoms of bladder dysfunction not responding to standard therapy alone. However, evidence of the effectiveness of biofeedback is scarce and is based on small studies. We conducted a systematic review of the literature to assess the effects of biofeedback as adjunctive therapy for symptoms of nonneuropathic voiding disorders in children up to age 18 years.
  
  
  METHODS
  We searched MEDLINE(®), Embase(®) and CENTRAL on the OvidSP(®) platform as well as conference proceedings for randomized trials presented at scientific conventions, symposia and workshops through August 13, 2013. Hand searches and review of reference lists of retrieved articles were also performed.
  
  
  RESULTS
  Five eligible studies were included in the systematic review, of which 4 (382 participants) were pooled in the meta-analysis based on available outcomes data. The overall proportion of cases with resolved incontinence at month 6 was similar in the biofeedback and control groups (OR 1.37 [95% CI 0.64 to 2.93], RD 0.07 [-0.09, 0.23]). There was also no significant difference in mean maximum urinary flow rate (mean difference 0.50 ml, range -0.56 to 1.55) or likelihood of urinary tract infection (OR 1.30 [95% CI 0.65 to 2.58]).
  
  
  CONCLUSIONS
  Current evidence does not support the effectiveness of biofeedback in the management of children with nonneuropathic voiding disorders. More high quality, randomized controlled trials are needed to better evaluate the effect of biofeedback.
authors: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Mir Sohail
authors: MS
authors: Fazeli
authors: School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Yiqun
authors: Y
authors: Lin
authors: School of Public and Population Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Nooshin
authors: N
authors: Nikoo
authors: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Sravan
authors: S
authors: Jaggumantri
authors: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Jean-Paul
authors: JP
authors: Collet
authors: Department of Urology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: kafshar@cw.bc.ca.
authors: Kourosh
authors: K
authors: Afshar
mesh_terms: D001676:Biofeedback, Psychology; D002648:Child; D053207:Diurnal Enuresis / Q000628:therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
keywords: child; diurnal enuresis; neurogenic; randomized controlled trials as topic; urinary bladder