Urodynamic Biofeedback: A New Therapeutic Approach for Childhood Incontinence/Infection (Vesical Voluntary Sphincter Dyssynergia)

Abstract

A major cause of urinary incontinence and/or recurrent urinary infections in neurologically intact children is vesical voluntary sphincter/urogenital diaphragm dyssynergia and/or "strain" dyssynergia. These acquired or learned mechanisms are characterized by increased striated muscle tone during micturition, residual urine, daytime wetting and/or urinary infections. Generally, pharmacotherapy is prescribed and manipulated to achieve modification of these dysfunctions. Recently, urodynamic biofeedback has surfaced as a suitable therapeutic alternative. We selected 10 children, between 6 1/2 and 16 years old, for biofeedback therapy because of age, intelligence, commitment and conviction to improve. Following inpatient biofeedback 8 of the 10 children demonstrated complete abatement of signs and symptoms in long-term surveillance (6 to 19 months after biofeedback), while 2 moderately improved. Our experience with biofeedback therapy demonstrated that all patients convert to synergistic voiding within 48 hours of therapy. Urodynamic biofeedback appears to be an extremely useful tool in the armamentarium of the urologist treating neurologically normal children with voiding disorders. The possibility that this modality may be useful for adults is intriguing.