The usefulness of a minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction

Objective To report our experience of assessing children with chronic voidi ng dysfunction (> 6 months' duration) using a minimal urodynamic evaluation , and the management of detrusor-sphincter dyscoordination (DSdc) using pel vic floor biofeedback. Patients and methods From 1994 to 1997, 120 children (mean age 7.5 years) w ith three predominant and associated symptoms were referred to one urologis t; they had nocturnal enuresis (28 children), urge incontinence (42) or uri nary tract infection (50). All patients were assessed by urinary culture, r enal ultrasonography and a minimal urodynamic evaluation, i.e. urinary flow metry with sphincter electromyography (EMG) using perineal surface electrod es. If they had urinary tract infection and/or renal dilatation, they under went voiding cysto-urethrography. In children with DSdc, urinary training w ith frequent voiding was instituted initially, with subsequent pelvic floor biofeedback exercises if the improvement was deemed unsatisfactory. Results DSdc was diagnosed in 33 children (28%), none of whom had isolated nocturnal enuresis. Pelvic floor biofeedback was undertaken by 15 children (12 girls and three boys); it was well accepted because it was administered as a computer game. In all affected patients the DSdc resolved on EMG and there was a significant clinical improvement. Vesico-ureteric reflux was de tected in 24 patients, associated with DSdc in 10. The reflux resolved spon taneously on antibiotic prophylaxis in six children and after urinary re-ed ucation in four. Conclusion A minimal urodynamic evaluation seems to be useful in the diagno sis of DSdc which caused urinary tract infection and/or bladder overactivit y. The results with pelvic floor biofeedback were excellent in these childr en.