Urotherapy and biofeedback resistant dysfunctional voiding: How to deal with?

IF 1.5 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms Pub Date : 2024-06-25 DOI:10.1111/luts.12528

M. İrfan Dönmez, Ismail Selvi, Tayfun Oktar, Orhan Ziylan

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引用次数: 0

Abstract

Objectives

To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV).

Methods

Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted.

Results

Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%.

Conclusions

Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.

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泌尿系统治疗和生物反馈治疗可缓解排尿功能障碍：如何处理？

目的分析具有治疗耐药性的排尿功能障碍（DV）儿童的治疗策略。方法回顾性分析2013年至2020年间接受盆底生物反馈疗法（BF）治疗的75名排尿功能障碍儿童，其中16名患者（14名女孩，87.5%）在接受尿路治疗和首次BF治疗后出现不完全临床反应，平均年龄为（9.81 ± 2.53）岁。记录了初次 BF 治疗前后的人口统计学和临床特征、DVSS 和尿流测量参数。记录了患者在初次 BF 治疗后的后续治疗情况和临床反应。结果一名患者在使用抗胆碱能药物后取得了临床成功，三名患者在联合使用挽救性膀胱刺激疗法和抗胆碱能药物后取得了临床成功，这些患者均以膀胱过度活动症（OAB）症状为主。单独使用 TENS 或与其他治疗方法联合使用的成功率为 88.8%（8/9 例患者）。此外，在与抗胆碱能药物或 TENS 联合使用的 10 个病例中，有 5 例（50%）患者通过抢救性 BF 治疗（2 至 3 次）取得了临床成功。对于排空不全但无 OAB 的病例，在平均 29 个月的随访期间，观察到两名对阿尔法受体阻滞剂无反应的男孩对 A 型肉毒杆菌产生了充分的临床反应，尽管其中一人在 10 个月后需要再次注射。中位随访 24 个月后，总临床成功率为 87.5%（14/16 名患者）。VV-EBC 和 Qmax 平均分别增加了 30.89% 和 7.13 mL/min，而 DVSS 平均下降了 8.88 点，PVR-EBC 中位下降了 19.04%。结论我们的研究结果表明，通过各种联合治疗，大多数患儿的耐药 DV 临床治疗取得了成功。然而，尽管采用了多种治疗方法，仍有一小部分患儿可能会持续出现令人烦恼的症状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

LUTS: Lower Urinary Tract Symptoms UROLOGY & NEPHROLOGY-

CiteScore

3.00

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： LUTS is designed for the timely communication of peer-reviewed studies which provides new clinical and basic science information to physicians and researchers in the field of neurourology, urodynamics and urogynecology. Contributions are reviewed and selected by a group of distinguished referees from around the world, some of whom constitute the journal''s Editorial Board. The journal covers both basic and clinical research on lower urinary tract dysfunctions (LUTD), such as overactive bladder (OAB), detrusor underactivity, benign prostatic hyperplasia (BPH), bladder outlet obstruction (BOO), urinary incontinence, pelvic organ prolapse (POP), painful bladder syndrome (PBS), as well as on other relevant conditions. Case reports are published only if new findings are provided. LUTS is an official journal of the Japanese Continence Society, the Korean Continence Society, and the Taiwanese Continence Society. Submission of papers from all countries are welcome. LUTS has been accepted into Science Citation Index Expanded (SCIE) with a 2011 Impact Factor.