BIOFEEDBACK THERAPY FOR CHILDREN WITH DYSFUNCTIONAL VOIDING

Objectives. Biofeedback therapy has been recognized as a treatment opt ion for children with classic dysfunctional voiding (DV) where there i s inadequate pelvic floor relaxation during voiding. However, there ar e few articles that discuss methodology and limited sites where it is available. In the hope of making biofeedback a more practical and acce ssible option, we report our indications, easy to duplicate methodolog y, and results. Methods. Twenty-one consecutive children diagnosed wit h DV refractory to standard therapy were enrolled in our biofeedback p rogram. Therapy consisted of extensive age-appropriate explanations of DV and demonstrations of normal and abnormal voiding patterns. Cyclic uroflow studies with pelvic floor electromyography are performed, whi ch the child monitors on analog chart and audio recorders. The child r eturns weekly until consistent relaxation of the pelvic floor during v oiding is demonstrated, Timing between sessions is then increased to m onitor progress and retention of concepts previously taught. Results. An excellent clinical response was one in which there was consistent r elaxation of the pelvic floor throughout voiding, normal flow pattern, and no residual urine volume (urodynamic response), coupled with prof ound resolution of voiding symptoms. Seventeen of 21 (81%) had an exce llent response, 3 (14%) had a fair response, and 1 (5%) was too incons istent to rate. The average number of sessions to achieve a consistent urodynamic response was 3.7 (range 2 to 14) and full clinical respons e somewhat longer. Average follow-up since beginning therapy has been 34 months (range 14 to 51). Conclusions. Biofeedback therapy is an eff ective method for treating DV with poor pelvic floor relaxation. Altho ugh initially labor intensive, it yields sustained positive results in most patients in a short time. UROLOGY 52: 312-315, 1998. (C) 1998, E lsevier Science Inc. All rights reserved.