Biofeedback therapy is an effective but resource intensive treatment for pediatric
dysfunctional voiding. Based on our center’s experience, we evaluated the rate of
clinical improvement from biofeedback in order to identify the maximum number of sessions
to offer patients.
We reviewed 490 pediatric patients who underwent at least 6 sessions of biofeedback
from 2013 to 2021. At each session, patients and their parents documented their urinary
symptoms (urgency, frequency, pain, and difficulties with stream), incontinence, medications,
and stool pattern. This longitudinal data was abstracted, and the log odds of urinary
symptoms or incontinence was modelled with number of sessions as a predictor using
generalized estimating equations and robust standard errors in SAS v9.4. Gender and
bowel dysfunction were included as interactions terms. A logistic regression using
absence of urinary symptoms at last biofeedback session as a dependent variable was
done to further explore differences between genders.
Patients were predominantly female (324/490, 66%) with a mean age of 8.9 years (SD
3.3 years). Most common symptoms at presentation were urinary urgency (389/490, 79%)
and urinary incontinence (413/490, 84%). Medication use was common at the time of
the first session (191/490, 39%) with males more likely to be on alpha-blockers (54/166
vs 1/324, p < 0.001) and females more likely to be on antibiotic prophylaxis (68/324
vs 2/166, p < 0.001).
The probability of having urinary symptoms or incontinence decreased up to session
11 (9 months from initial visit). There was slower rate of improvement after session
8 (3 months). Controlling for age, symptoms, and medication use at initial visit,
male patients were less likely to report symptom resolution at the time of the last
session (OR 0.55, 95% CI 0.33, 0.89). The nadir for reporting symptoms occurred by
session 22 for male patients, compared to session 10 for female patients.
Clinical improvement from biofeedback for pediatric patients with dysfunctional voiding
may take up to 9 months of therapy, but most cases that improve do so by 3 months.
The effect of gender on biofeedback efficacy requires further study, but males may
have slower response to biofeedback. Our data provides guidance on when maximum benefit
from biofeedback can be expected before considering re-evaluation or other therapies
for lower urinary tract symptoms.