title: Management of non-neuropathic underactive bladder in children with voiding dysfunction by animated biofeedback: a randomized clinical trial.
abstract: OBJECTIVE
  To assess the efficacy of animated biofeedback and pelvic floor muscle (PFM) exercise in managing children with non-neuropathic underactive bladder (UB).
  
  
  METHODS
  A total of 50 children with UB without underlying neuropathic disease, aged 5-16 years, were included in this study. They were randomly divided into 2 equal treatment groups comprising standard urotherapy (hydration, scheduled voiding, toilet training, and diet) with (group A) or without (group B) animated biofeedback and PFM exercise. The follow-up period for each participant was 1 year. A complete voiding and bowel habit diary was recorded by participants' parents before and after 2 evaluations. In addition, uroflowmetry with electromyography and bladder ultrasound were performed before, 6 months, and 1 year after treatment. Results were compared between the 2 cohorts.
  
  
  RESULTS
  Mean number of voiding episodes was significantly increased in group A after biofeedback therapy compared with group B with only standard urotherapy (6.6 ± 1.6 vs 4.5 ± 1 times a day; P <.000). Urinary tract infection did not relapse in 9 of 11 (81%) and 8 of 15 (38%) patients in groups A and B, respectively (P <.02). Postvoid residual volume and voiding time decreased considerably, whereas maximum urine flow increased significantly in group A compared with group B (17.2 ± 4.7 vs 12.9 ± 4.6 mL/s; P <.01).
  
  
  CONCLUSIONS
  Combination of animated biofeedback and PFM exercise effectively improves sensation of bladder fullness and contractility in children with UB due to voiding dysfunction.
authors.affiliation: Pediatric Urology Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
authors.forename: Sanam
authors.initials: S
authors.lastname: Ladi-Seyedian
authors.affiliation: Pediatric Urology Research Center, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI). Electronic address: kajbafzd@sina.tums.ac.ir.
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.affiliation: Department of Physical Therapy, Children's Hospital Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran (IRI).
authors.forename: Lida
authors.initials: L
authors.lastname: Sharifi-Rad
authors.affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Babak
authors.initials: B
authors.lastname: Shadgan
authors.affiliation: UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin, Ireland.
authors.forename: Eileen
authors.initials: E
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D017773:Pelvic Floor; D001745:Urinary Bladder Diseases / Q000628:therapy*; D014555:Urination Disorders / Q000628:therapy*