Research: HERNDON and colleagues,

Listed in Issue 74

Abstract

HERNDON and colleagues, University of Connecticut Health Center, Farmington, Connecticut, USA, extended their previous studies, in children with voiding dysfunction, of a treatment programme involving computer game-assisted pelvic floor muscle (CG-PFM) retraining. The authors wished to review their experience with a conservative medical programme and CG-PFM retraining, in order to substantiate their previous findings of improvement and/or cure in a majority of children with voiding dysfunction and to identify factors that might be associated with unsuccessful treatment.

Background

Methodology

The investigators examined all children enrolled in their pelvic floor muscle retraining and subjectively evaluated them for improvement in nocturnal enuresis, diurnal enuresis, constipation, encopresis and incidence of break-through urinary tract infection (UTI). Children in whom the initial conservative approach that included the biofeedback programme (CG-PFM) failed were further treated with medication and their outcomes were also reviewed. Fisher's exact test was used to identify factors that might predict failure with the programme.

Results

Over the previous 2 years, 134 girls and 34 boys had been enrolled in the pelvic floor muscle retraining programme. Of these children, 160 (95%) [remained] compliant with the programme. The mean age was 7.6 years (range 4-18). The average number of hourly treatment sessions was 4.9 (range 2-13). 32% of children showed uroflowmetry (UFM) and electromyography (EM) with a flattened flow pattern and increased post-void residual volume ; 47% showed UFM and EM with a flattened flow pattern and normal post-void residual volume ; 11% had UFM and EM with a staccato flow pattern and increased post-void residual volume ; and 10% had UFM and EM with a staccato flow pattern and normal post-void residual volume . 87% of children (146) demonstrated subjective improvement, while 13% (22) had no improvement . Statistically significant predictors of failure included bladder capacity less than 60% of predicted volume and patient non-compliance. 12 children who had no improvement with biofeedback were treated with medication and 10 (83%) improved. Multichannel urodynamics or spinal magnetic resonance imaging (MRI) was obtained in only 7 children (4%) with no neurological lesion identified by spinal MRI.

Conclusion

A conservative programme combined with CG-PFM retraining improved symptoms in most children with voiding dysfunction. A majority of children could be treated without medication . In a select population of children with a small bladder capacity in whom biofeedback failed, anticholinergic medication appeared to alleviate symptoms. In the investigators' experience, almost all children with voiding dysfunction could be treated with multichannel urodynamics, spinal MRI or medication.

References

Herndon CD et al. Interactive computer games for treatment of pelvic floor dysfunction. The Journal of Urology 166 (5): 1893-8. Nov 2001.

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