Abstract
We assessed efficacy of biofeedback therapy and home pelvic floor muscle exercises in children with dysfunctional voiding (DV) associated with mild to moderate hydronephrosis. This prospective study comprised fifty seven children (21 boys, 36 girls; mean age 8.9 ± 2.6) with DV and mild to moderate hydronephrosis. Children were randomly allocated into two treatment groups including control group who underwent standard urotherapy and case group who received biofeedback therapy in addition to standard urotherapy. A 99mTc diethylenetriamine pentaacetic acid (99mDTPA) scan, voiding cystoureterography, kidney and bladder ultrasounds, voiding diary and uroflowmetry with electromyography (EMG) were performed in all study participants at the baseline. Children with evidence of complete obstruction in DTPA scan and vesicoureteral reflux were excluded from enrollment. A complete voiding diary, kidney and bladder ultrasounds and uroflowmetry/EMG were also performed 6 months and 1 year after completion of the treatment. We noted a more significant decline in anteroposterior pelvic diameter in case group compared to control group (P < 0.05). The mean maximal urine flow rate prior to treatment was 16.5 ± 2.6 and 16.1 ± 3 ml/s in case and control groups, respectively. This finding increased significantly 1 year after the treatment in case group compared to controls (25 ± 7.2 ml/s vs. 18.4 ± 5.9 ml/s, respectively; P < 0.001). Improvement of various parameters in voiding diary was also more significant in the case group. Biofeedback therapy can effectively resolve non-refluxing and non-obstructive hydronephrosis in children with DV.
Similar content being viewed by others
Abbreviations
- APPD:
-
Anteroposterior pelvic diameter
- BT:
-
Biofeedback therapy
- DV:
-
Dysfunctional voiding
- ICCS:
-
International Children’s Continence Society
- EMG:
-
Electromyography
- PVR:
-
Post void residual
- PFM:
-
Pelvic floor muscle
- SUT:
-
Standard urotherapy
- UTI:
-
Urinary tract infection
- VUR:
-
Vesicoureteral reflux
References
Austin, P. F., Bauer, S. B., Bower, W., Chase, J., Franco, I., Hoebeke, P., et al. (2016). The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children’s Continence Society. Neurourology and Urodynamics, 35(4), 471–481. https://doi.org/10.1002/nau.22751.
Berry, A., Rudick, K., Richter, M., & Zderic, S. (2014). Objective versus subjective outcome measures of biofeedback: What really matters? Journal of Pediatric Urology, 10(4), 620–626. https://doi.org/10.1016/j.jpurol.2014.06.003.
Chase, J., Austin, A., Hoebeke, P., & MaKenna, P. (2010). The management of dysfunctional voiding in children: A report from the standardization committee of the International Children’s Continence Society. Journal of Urology, 183, 1296–1302.
Fazeli, M. S., Lin, Y., Nikoo, N., Jaggumantri, S., Collet, J. P., & Afshar, K. (2015). Biofeedback for nonneuropathic daytime voiding disorders in children: A systematic review and meta-analysis of randomized controlled trials. Journal of Urology, 193(1), 274–279. https://doi.org/10.1016/j.juro.2014.07.097.
Fernbach, S. K., Maizels, M., & Conway, J. J. (1993). Ultrasound grading of hydronephrosis: Introduction to the system used by the Society for Fetal Urology. Pediatric Radiology, 23(6), 478–480.
Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology, 150(6), 1456–1468. https://doi.org/10.1053/j.gastro.2016.02.015.
Kajbafzadeh, A. M., Sharifi-Rad, L., Ghahestani, S. M., Ahmadi, H., Kajbafzadeh, M., & Mahboubi, A. H. (2011). Animated biofeedback: An ideal treatment for children with dysfunctional elimination syndrome. Journal of Urology, 186(6), 2379–2384. https://doi.org/10.1016/j.juro.2011.07.118.
Kajbafzadeh, A. M., Mehdizadeh, M., Aryan, Z., Ebadi, M., Esfahani, S. A., Montaser-Kouhsari, L., et al. (2014). Drainage-related ultrasonography (DRUS): A novel technique for discriminating obstructive and nonobstructive hydroureters in children. The Journal of Ultrasound, 18(2), 117–125. https://doi.org/10.1007/s40477-014-0128-z.
Khen-Dunlop, N., Van Egroo, A., Bouteiller, C., Biserte, J., & Besson, R. (2006). Biofeedback therapy in the treatment of bladder overactivity, vesico-ureteral reflux and urinary tract infection. J Pediatr Urol., 2(5), 424–429. https://doi.org/10.1016/j.jpurol.2005.09.004.
Kibar, Y., Ors, O., Demir, E., Kalman, S., Sakallioglu, O., & Dayanc, M. (2007). Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux. Urology, 70(3), 563–566. (discussion 566–567).
Kibar, Y., Piskin, M., Irkılata, H. C., Aydur, E., Gok, F., & Dayanc, M. (2010). Management of abnormal post void residual urine in children with dysfunctional voiding. Urology, 75(6), 1472–1475. https://doi.org/10.1016/j.urology.2009.09.008.
Ladi-Seyedian, S., Kajbafzadeh, A. M., Sharifi-Rad, L., Shadgan, B., & Fan, E. (2015). Management of non-neuropathic underactive bladder in children with voiding dysfunction by animated biofeedback: a randomized clinical trial. Urology, 85(1), 205–210. https://doi.org/10.1016/j.urology.2014.09.025.
Ladi-Seyedian, S. S., Sharifi-Rad, L., & Kajbafzadeh, A. M. (2019). Pelvic floor electrical stimulation and muscles training: A combined rehabilitative approach for management of non-neuropathic urinary incontinence in children. Journal of Pediatric Surgery, 54(4), 825–830. https://doi.org/10.1016/j.jpedsurg.2018.06.007.
Nordenström, J., Sjöström, S., Sillén, U., Sixt, R., Brandström, P., Nordenström, J., et al. (2017). The Swedish infant high-grade reflux trial: UTI and renal damage. Journal of Pediatric Urology, 13(2), 146–154. https://doi.org/10.1016/j.jpurol.2016.12.023.
Oktar, T., Dönmez, M. İ., Özkuvancı, Ü., Ander, H., & Ziylan, O. (2018). Animated versus non-animated biofeedback therapy for dysfunctional voiding treatment: Does it change the outcome? Journal of Pediatric Surgery, 53(4), 825–827. https://doi.org/10.1016/j.jpedsurg.2017.06.002.
Roihuvuo-Leskinen, H. M., Koskimäki, J. E., Tammela, T. L., & Lahdes-Vasama, T. T. (2008). Urine flow curve shapes in adults with earlier vesicoureteral reflux. European Urology, 54(1), 188–194.
Sener, N. C., Altunkol, A., Unal, U., Ercil, H., Bas, O., Gumus, K., et al. (2015). Can a four-session biofeedback regimen be used effectively for treating children with dysfunctional voiding? 47(1), 5–9. https://doi.org/10.1007/s11255-014-0837-4.International Urology and Nephrology
Sharifi-Rad, L., Ladi-Seyedian, S. S., Amirzargar, H., & Kajbafzadeh, A. M. (2018). Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms. International Brazilian Journal of Urology, 44(6), 1207–1214. https://doi.org/10.1590/S1677-5538.
Sinha, S. (2011). Dysfunctional voiding: A review of the terminology, presentation, evaluation and management in children and adults. Indian Journal of Urology, 27(4), 437–447. https://doi.org/10.4103/0970-1591.91429.
Vega-P, J. M., & Pascual, L. A. (2001). High-pressure bladder: An underlying factor mediating renal damage in the absence of reflux? BJU International, 87(6), 581–584.
Vemulakonda, V., Yiee, J., & Wilcox, D. T. (2014). Prenatal hydronephrosis: Postnatal evaluation and management. Current Urology Reports, 15(8), 430. https://doi.org/10.1007/s11934-014-0430-5.
Acknowledgement
We are highly grateful to Mrs. Safieh Lotfi for her precise final linguistic revision of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in the study involving human participants were in accordance with the ethical standards of the local ethics committee of Tehran University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ladi-Seyedian, SS., Sharifi-Rad, L., Amini, E. et al. Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical Trial. Appl Psychophysiol Biofeedback 45, 259–266 (2020). https://doi.org/10.1007/s10484-020-09474-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10484-020-09474-z