Interactive computer games for treatment of pelvic floor dysfunction

Purpose: We reviewed our experience with a conservative medical program and computer game assisted pelvic floor muscle retraining in patients with voi ding dysfunction to substantiate our previous findings that demonstrated im provement and/or cure in a majority of patients, and identify factors that may be associated with unsuccessful treatment. Materials and Methods: All patients presenting with symptoms of dysfunction al voiding enrolled in our pelvic floor muscle retraining were examined. Ca ses were subjectively evaluated for improvement of nocturnal enuresis, diur nal enuresis, constipation, encopresis and incidence of break through urina ry tract infection. Patients in whom our initial conservative approach that included our biofeedback program failed were further treated with medicati on, and outcomes were reviewed as well. Fisher's exact test was used for st atistical analysis to identify factors that may predict failure with our pr ogram. Results: During the last 2 years 134 girls and 34 boys were enrolled in the pelvic floor muscle retraining program. Of the patients 160 (95%) were com pliant with the program. Mean patient age was 7.6 years (range 4 to 18). Th e average number of hourly treatment sessions was 4.9 (range 2 to 13). Urof lowmetry and electromyography demonstrated a flattened flow pattern with in creased post-void residual volume in 32% of patients, flattened flow patter n with normal post-void residual 47%, staccato flow pattern with increased post-void residual 11% and staccato flow pattern with normal post-void resi dual 10%. Subjective improvement was demonstrated in 87% (146) of patients, while 13% (22) had no improvement. Statistically significant predictors of failure included bladder capacity less than 60% of predicted volume (p <0. 03) and patient noncompliance (p <0.04). Twelve patients who had no improve ment with biofeedback were treated with medication and 10 (83%) improved. M ultichannel urodynamics or spinal magnetic resonance imaging (MRI) was obta ined in only 7 (4%) of our patients with no neurological lesion identified by spinal MRI. Conclusions: A conservative program combined with computer game assisted pe lvic floor muscle retraining improves symptoms in most patients with voidin g dysfunction. A majority of patients can be treated without medication. Ho wever, in a select population of patients with a small capacity bladder in whom biofeedback fails, anticholinergic medication appears to alleviate sym ptoms. In our experience almost all patients presenting with symptoms of vo iding dysfunction can be treated without multichannel urodynamics, spinal M RI or medication.