Biofeedback Therapy for Dysfunctional Voiding in Children
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA. Current Urology Reports
(Impact Factor: 1.51).
04/2011; 12(2):144-52. DOI: 10.1007/s11934-010-0166-9
The past decade has seen a dramatic shift in the management of lower urinary tract dysfunction, including dysfunctional voiding, in children. Once treated primarily with medication, dysfunctional voiding now is managed successfully in most cases with noninvasive evaluations and biofeedback-based pelvic floor muscle retraining. Introduced in 1979, biofeedback initially was expensive and labor intensive, requiring inpatient treatment. The use of animated computer games has expedited results, allowing excellent resolution of dysfunctional voiding and coexisting conditions such as vesicoureteral reflux and constipation with outpatient treatment. Morbidity from medications and surgical procedures has been reduced at centers using biofeedback. Future goals of biofeedback therapy should include further refinements in technique and increasing access to care.
Available from: Jose De Bessa Junior
- "The prevalence of LUTS in individuals with DS found in the present study was 27.3%, in accordance with others studies that have demonstrated 20e30% of children have dysfunctional voiding  . Our findings were also similar to the study of Vaz et al. , including 739 Brazilian typically developed students, in which the prevalence of LUTS was estimated to be 21.8%. "
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ABSTRACT: Down syndrome (DS), which is caused by the trisomy of chromosome 21, is the most frequent of all genetic syndromes. The current study aims to estimate the prevalence of lower urinary tract symptoms (LUTS) in individuals with DS buy using the Dysfunctional Voiding Symptom Score (DVSS) and correlate with functional constipation, age, and gender, as well as determine the most sensitive and specific factors associated with LUTS.
LUTS was assessed in individuals with DS using a cross-sectional study through the application of a validated and adapted version of the DVSS for the Brazilian population. The presence of functional constipation was evaluated according to the Rome III criteria.
Of the 114 individuals assessed, 84 were included in the study (median age 16 ± 5.0 years, 66.7% female). The prevalence of LUTS was 27.3%. The symptoms were more frequent in males (OR 3.0, 95% CI 1.1-8.3, p = 0.03) and in individuals younger than 10 years of age (OR 5.2, 95% CI 1.8-14, p = 0.001). Functional constipation was observed in 50% of subjects. It was detected in 95.65% of the individuals with LUTS and 32.78% without LUTS (OR 45.1, 95% CI 5.66-301, p = 0.001). The symptom listed in question 8 ("push to pee") was the most specific indicator. When present, this symptom indicated a higher probability of LUTS (LR+ = 6.3), while the symptom listed in question 4 ("push for bowel movements to come out") showed high sensitivity and, when absent, indicated a lower probability of LUTS (LR- = 0.1).
LUTS was more prevalent in young males with DS and appeared to improve with age. Functional constipation was strongly associated with LUTS. These findings will contribute to raising the awareness of professionals involved in the follow-up of individuals with DS regarding the clinical manifestations and the need for a standardized investigation of LUTS.
Available from: Pieter Dik
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ABSTRACT: To study the clinical and urodynamic parameters of children who developed bladder diverticula (BD) after ureteral reimplantation.
We have reviewed records of 15 children who underwent ureteric reimplantation, possibly with diverticulectomy between January 1998 and October 2004, who postoperatively developed BD and compared the results with 25 patients, surgically treated for primary vesicoureteric reflux (VUR) without BD development after reimplantation. A total of 737 reimplantations was performed in 492 patients. Of the 15 patients and 25 controls we reviewed voiding history and free uroflowmetry, urodynamic parameters, findings on urethrocystoscopy, VCUG and signs of dysfunctional or anatomical obstruction.
Of the fifteen patients with a postoperative diverticulum, one patient (7%) had an infravesical obstruction in combination with a normal voiding pattern, nine patients (60%) had severe dysfunctional voiding and two patients (13%) had both. Three patients had no infravesical obstruction nor dysfunctional voiding. Urodynamically the mean Pmax postoperatively was 96.8 (cm-H(2)O) in the obstructed patients (BD-group) (in controls 50.0 cm-H(2)O) and 95.6 (cm-H(2)O) for the dysfunctional voiders (in controls 61.8 cm-H(2)O). The difference between the Pmax values of BD-group and controls was significant on the 95% C.I. (P < 0.01).
Dysfunctional voiding and infravesical obstruction in children appear to be important risk factors for acquired BD. Voiding pressures are significantly higher in patients that developed BD. Cognitive bladder training to normalize voiding pressures should be done before surgery if feasible. Special attention should be paid to the persistence of an infravesical obstruction.
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