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Biofeedback in the Management of Urinary Continence in Children

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Abstract

Significant progress has been made over the past 15 years regarding the development of bladder control and the evaluation and management of pediatric voiding dysfunction. Incontinence is a problem of significant social consequence that is commonly due to dysfunctional voiding (ie, discoordination between the detrusor and the external sphincter). Biofeedback was introduced in 1979 but was relatively forgotten until the late 1990 s. Nonanimated biofeedback relates sphincter activity to electromyographic activity as reflected as tracing on a computer screen or auditory feedback. This successful modality was exclusively available until recently when animated biofeedback became available, allowing for a more rapid grasp of the physiologic event to be modulated. Biofeedback has been shown to be very effective in children to correct incontinence secondary to dysfunctional voiding, as well as in treating giggle incontinence and to help resolve vesicoureteral reflux.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Brazelton TB, Christophersen ER, Frauman AC, et al.: Instruction, timeliness and medical influences affecting toilet training. Pediatrics 1999, 103:1353–1358.

    CAS  PubMed  Google Scholar 

  2. Jansson UB, Hanson M, Sillen U, Hellstrom AL: Voiding pattern and acquisition of bladder control from birth to age 6 years: a longitudinal study. J Urol 2005, 174:289–293.

    Article  PubMed  Google Scholar 

  3. Yeung CK, Godley ML, Ho CK, et al.: Some new insights into bladder function in infancy. Br J Urol 1995, 76:235–240.

    Article  CAS  PubMed  Google Scholar 

  4. Yeung CK, Godley ML, Duffy PG, Ransley PG: Natural filling cystometry in infants and children. Br J Urol 1995, 75:531–537.

    Article  CAS  PubMed  Google Scholar 

  5. Wen JG, Tong EC: Cystometry in infants and children with no apparent voiding symptoms. Br J Urol 1998, 81:468–473.

    CAS  PubMed  Google Scholar 

  6. Sillen U, Solsnes E, Hellstrom AL, Sandberg K: The voiding pattern of healthy preterm neonates. J Urol 2000, 163:278–281.

    Article  CAS  PubMed  Google Scholar 

  7. Holmdahl G, Hanson E, Hanson M, et al.: Four-hour voiding observation in healthy infants. J Urol 1996, 156:1809–1812.

    Article  CAS  PubMed  Google Scholar 

  8. Nash DF: The development of micturition control with special reference to enuresis. Ann R Coll Surg Engl 1949, 5:318–344.

    CAS  PubMed  Google Scholar 

  9. Berger RM, Maizels M, Moran GC, et al.: Bladder capacity (ounces) equals age (years) plus 2 predicts normal bladder capacity and aids in diagnosis of abnormal voiding patterns. J Urol 1983, 129:347–349.

    CAS  PubMed  Google Scholar 

  10. Jansson UB, Hanson M, Hanson E, et al.: Voiding pattern in healthy children 0 to 3 years old: a longitudinal study. J Urol 2000, 164:2050–2054.

    Article  CAS  PubMed  Google Scholar 

  11. Klijn AJ, Uiterwaal CS, Vijverberg MA, et al.: Home uroflowmetry biofeedback in behavioral training for dysfunctional voiding in school-age children: a randomized controlled study. J Urol 2006, 175:2263–2268.

    Article  PubMed  Google Scholar 

  12. Maizels M, King LR, Firlit CF: Urodynamic biofeedback: a new approach to treat vesical sphincter dyssynergia. J Urol 1979, 122:205–209.

    CAS  PubMed  Google Scholar 

  13. Hoebeke P, Vande Walle J, Theunis M, et al.: Outpatient pelvic-floor therapy in girls with daytime incontinence and dysfunctional voiding. Urology 1996, 48:923–927.

    Article  CAS  PubMed  Google Scholar 

  14. De Paepe H, Renson C, Van Laecke E, et al.: Pelvic-floor therapy and toilet training in young children with dysfunctional voiding and obstipation. BJU Int 2000, 85:889–893.

    Article  PubMed  Google Scholar 

  15. Wiener JS, Scales MT, Hampton J, et al.: Long-term efficacy of simple behavioral therapy for daytime wetting in children. J Urol 2000, 164:786–790.

    Article  CAS  PubMed  Google Scholar 

  16. Chin-Peuckert L, Salle JL: A modified biofeedback program for children with detrusor-sphincter dyssynergia: 5-year experience. J Urol 2001, 166:1470–1475.

    Article  CAS  PubMed  Google Scholar 

  17. Vasconcelos M, Lima E, Caiafa L, et al.: Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol 2006, 21:1858–1864.

    PubMed  Google Scholar 

  18. Drzewiecki BA, Kelly PR, Marinaccio B, et al.: Biofeedback training for lower urinary tract symptoms: factors affecting efficacy. J Urol 2009,182:2050–2055.

    Article  PubMed  Google Scholar 

  19. Bower WF, Yew SY, Sit KY, Yeung CK: Half-day urotherapy improves voiding parameters in children with dysfunctional emptying. Eur Urol 2006, 49:570–574.

    Article  PubMed  Google Scholar 

  20. Schulman SL, Von Zuben FC, Plachter N, Kodman-Jones C: Biofeedback methodology: does it matter how we teach children how to relax the pelvic floor during voiding? J Urol 2001,166:2423–2426.

    Article  CAS  PubMed  Google Scholar 

  21. Nelson JD, Cooper CS, Boyt MA, et al.: Improved uroflow parameters and post-void residual following biofeedback therapy in pediatric patients with dysfunctional voiding does not correspond to outcome. J Urol 2004, 172:1653–1656.

    Article  PubMed  Google Scholar 

  22. Bael A, Lax H, de Jong TP, et al.; European Bladder Dysfunction Study (European Union BMH1-CT94-1006): The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J Urol 2008, 180:1486–1493.

    Article  PubMed  Google Scholar 

  23. Van Kampen M, Lemkens H, Deschamps A, et al.: Influence of pelvic floor muscle exercises on full spectrum therapy for nocturnal enuresis. J Urol 2009, 182:2067–2071.

    Article  PubMed  Google Scholar 

  24. McKenna PH, Herndon CD, Connery S, Ferrer FA: Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol 1999, 162:1056–1062.

    Article  CAS  PubMed  Google Scholar 

  25. Herndon CD, Decambre M, McKenna PH: Interactive computer games for treatment of pelvic floor dysfunction. J Urol 2001,166:1893–1898.

    Article  CAS  PubMed  Google Scholar 

  26. • Kaye JD, Palmer LS: Animated biofeedback yields more rapid results than non-animated biofeedback in the treatment of external sphincter overactivity in the pediatric population. J Urol 2008, 180:300–305. This is the first study to compare animated versus nonanimated biofeedback techniques. Animated biofeedback yields expedited success rates.

    Article  PubMed  Google Scholar 

  27. Allen HA, Austin JC, Boyt MA, et al.: Initial trial of timed voiding is warranted for all children with daytime incontinence. Urology 2007, 69:962–965.

    Article  PubMed  Google Scholar 

  28. Yucel S, Akkaya E, Guntekin E, et al.: Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. J Urol 2005, 174:1612–1615.

    Article  CAS  PubMed  Google Scholar 

  29. Radojicic ZI, Perovic SV, Milic NM: Is it reasonable to treat refractory voiding dysfunction in children with botulinum-A toxin? J Urol 2006, 176:332–336.

    Article  PubMed  Google Scholar 

  30. Petronijevic V, Lazovic M, Vlajkovic M, et al.: Botulinum toxin type A in combination with standard urotherapy for children with dysfunctional voiding. J Urol 2007, 178:2599–2602.

    Article  CAS  PubMed  Google Scholar 

  31. Pohl HG, Bauer SB, Borer JG, et al.: The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children. J Urol 2003,169:1603–1604.

    Google Scholar 

  32. MacKeith RC: Micturition induced by giggling. Arch Dis Child 1959, 34:250–260.

    Article  Google Scholar 

  33. De Jonge GA: Enuresis risoria. Ned Tijdschr Geneeskd 1975, 199:1335–1338.

    Google Scholar 

  34. Nevéus T, von Gontard A, Hoebeke P, et al.: The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006, 176:314–324.

    Article  PubMed  Google Scholar 

  35. Millard DW: A conditioning treatment for “giggle micturition.” Behav Res Devel 1966, 4:229–231.

    CAS  Google Scholar 

  36. Berry AK, Zderic S, Carr M: Methylphenidate for giggle incontinence. J Urol 2009, 182:2028–2032.

    Article  CAS  PubMed  Google Scholar 

  37. • Richardson I, Palmer LS: Successful treatment for giggle incontinence with biofeedback. J Urol 2009,182:2062–2066. This is the first paper to apply biofeedback to children with giggle incontinence. It concludes that biofeedback should be included in the management strategy of this condition

    Article  PubMed  Google Scholar 

  38. Hinman F, Baumann FW: Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive disease. J Urol 1973, 109:727–732.

    CAS  PubMed  Google Scholar 

  39. Allen TD: The non-neurogenic neurogenic bladder. J Urol 1977, 117:232–238.

    CAS  PubMed  Google Scholar 

  40. Snodgrass W: The impact of treated dysfunctional voiding on the nonsurgical management of vesicoureteral reflux. J Urol 1998,160:1823–1825.

    Article  CAS  PubMed  Google Scholar 

  41. Noe HN: The role of dysfunctional voiding in failure or complication of ureteral reimplantation for primary reflux. J Urol 1985, 134:1172–1175.

    CAS  PubMed  Google Scholar 

  42. Koff SA, Wagner TT, Jayanthi VR: The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 1998, 160:1019–1022.

    Article  CAS  PubMed  Google Scholar 

  43. Palmer LS, Franco I, Rotario P, et al.: Biofeedback therapy expedites the resolution of reflux in older children. J Urol 2002, 168:1699–1702.

    Article  PubMed  Google Scholar 

  44. Herndon CD, DeCambre M, McKenna PH: Changing concepts concerning the management of vesicoureteral reflux. J. Urol 2001, 166:1439–1443.

    Article  CAS  PubMed  Google Scholar 

  45. • Kibar Y, Ors O, Demir E, et al.: Results of biofeedback on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux. Urology 2007, 70:563–566. This paper corroborates the important role that identifying and treating dysfunctional voiding can have on spontaneous resolution of reflux

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Urology, Schneider Children’s Hospital of the North Shore-Long Island Jewish Health System, 1999 Marcus Avenue, Lake Success, NY, 11042, USA

    Lane S. Palmer

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  1. Lane S. Palmer
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Correspondence to Lane S. Palmer.

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Palmer, L.S. Biofeedback in the Management of Urinary Continence in Children. Curr Urol Rep 11, 122–127 (2010). https://doi.org/10.1007/s11934-010-0099-3

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  • DOI: https://doi.org/10.1007/s11934-010-0099-3

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