Biofeedback therapy in the treatment of bladder overactivity, vesico-ureteral reflux and urinary tract infection

Khen-Dunlop, Naziha; Van Egroo, Anne; Bouteiller, Cécile; Biserte, Jacques; Besson, Rémi

doi:10.1016/j.jpurol.2005.09.004

« Previous Next »Journal of Pediatric Urology
Volume 2, Issue 5 , Pages 424-429, October 2006

Biofeedback therapy in the treatment of bladder overactivity, vesico-ureteral reflux and urinary tract infection

Naziha Khen-Dunlop
- Department of Paediatric Surgery, Hopital Jeanne de Flandre, rue Oscar Lambret, 59 800 Lille, France
- Corresponding author. Hopital Armand Trousseau, Service de Chirurgie Pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France. Tel.: +33 1 44 73 69 89; fax: +33 1 44 73 69 79.
Anne Van Egroo
- Department of Paediatric Nephrology, Hopital Jeanne de Flandre, rue Oscar Lambret, 59 800 Lille, France
Cécile Bouteiller
- Paediatric Training Centre, Hopital Jeanne de Flandre, rue Oscar Lambret, 59 800 Lille, France
Jacques Biserte
- Department of Paediatric Surgery, Hopital Jeanne de Flandre, rue Oscar Lambret, 59 800 Lille, France
Rémi Besson
- Department of Paediatric Surgery, Hopital Jeanne de Flandre, rue Oscar Lambret, 59 800 Lille, France

Received 17 February 2005; accepted 7 September 2005.

Abstract

Objective

Voiding disorders are commonly encountered in paediatric urology practice. Urinary incontinence often leads to the impairment of self-esteem but can also cause renal damage, when recurrent urinary tract infection (UTI) or vesico-ureteral reflux (VUR) exists. The aim of this study was to assess the efficacy of a biofeedback training program in children with a long history of voiding disorders.

Patients and methods

Between 1998 and 2002, 60 children with voiding disorders without neuropathic disease, aged 5–14, were treated. There were 48 girls and 12 boys. The main symptoms were daytime incontinence for 90%, urge syndrome for 78%, and night-time incontinence for 60%. UTIs were noted in 62% of the children, for 37% of them in association with a VUR. Ten weekly sessions were planned for all the children. They were given instructions on toilet behaviour and posture, and pelvic floor training. They had to supervise their voiding frequency and liquid intake at home using a chart. Biofeedback procedure used surface perineal electrodes. The exercises focused on relaxation of the perineum.

Results

The first results were recorded 6 months after the last session: 96% of the children with daytime incontinence and 83% of the children with night-time incontinence were cured or improved; 84% of the children were free from infection and VUR was cured in 50% of cases. After a mean follow-up of 21 months, 8% of the children with daytime incontinence and 33% with night-time incontinence relapsed, with a significant difference between primary and secondary enuresis. A breakthrough UTI was observed in 19% of cases.

Conclusion

This non-invasive training program was effective in the treatment of daytime incontinence, UTI and VUR. There was an improvement in secondary but not primary enuresis. To prevent relapse, additional support sessions seem to be necessary.

Keywords: Voiding dysfunction, Biofeedback training, Pelvic floor, Enuresis