Carla Labonia Passos, Maria Beatriz Mendes Souza, Mila Torii Corrêa Leite, Bruna Cecilia Nunes Carvalho, Humberto Saconato, Luiz G Freitas Filho
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Gray literature was also searched using Google Scholar, ProQuest, and medRxiv.</p><p><strong>Results: </strong>Four randomized controlled trials were included, totaling 244 patients. The meta-analysis showed that EMGBF therapy significantly increased maximum urinary flow rate (MD: 4.69; 95% CI: 1.06-8.31), normalized voiding flow patterns (RR: 2.70; 95% CI: 1.43-5.10), reduced postvoid residual urine (MD: 11.11; 95% CI: 2.38-19.84), and improved enuresis (RR: 2.34; 95% CI: 1.05-5.20). Additionally, a subset of 17 patients with vesicoureteral reflux (VUR) was evaluated. Among those who underwent EMGBF, VUR resolution was observed in all but one patient with grade IV reflux. Reported resolution rates were 88.8% at 6 months and 77.7% at 1 year in the intervention group, compared with 37.5% and 12.5%, respectively, in the control group. However, these findings should be interpreted with caution given the limited number of patients and lack of randomization for VUR-specific outcomes.</p><p><strong>Conclusion: </strong>EMGBF is an effective and well-tolerated intervention for treating dysfunctional voiding in children and adolescents. Benefits include improvements in urinary symptoms, urodynamic parameters, and infection rates. Although preliminary findings suggest a possible positive effect on VUR, further high-quality trials are warranted to confirm these observations and to optimize therapeutic protocols.</p>","PeriodicalId":23415,"journal":{"name":"Urology","volume":" ","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Electromyographic Biofeedback for Dysfunctional Voiding in Children and Adolescents: A Systematic Review and Meta-analysis of Randomized Trials.\",\"authors\":\"Carla Labonia Passos, Maria Beatriz Mendes Souza, Mila Torii Corrêa Leite, Bruna Cecilia Nunes Carvalho, Humberto Saconato, Luiz G Freitas Filho\",\"doi\":\"10.1016/j.urology.2025.08.046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess the efficacy of electromyographic biofeedback (EMGBF) in the treatment of dysfunctional voiding (DV) in children and adolescents by synthesizing evidence from randomized controlled trials.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized and controlled trials evaluating EMGBF therapy in pediatric patients diagnosed with DV. Searches were performed across seven databases (Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Livivo, and LILACS) up to January 2025. Gray literature was also searched using Google Scholar, ProQuest, and medRxiv.</p><p><strong>Results: </strong>Four randomized controlled trials were included, totaling 244 patients. The meta-analysis showed that EMGBF therapy significantly increased maximum urinary flow rate (MD: 4.69; 95% CI: 1.06-8.31), normalized voiding flow patterns (RR: 2.70; 95% CI: 1.43-5.10), reduced postvoid residual urine (MD: 11.11; 95% CI: 2.38-19.84), and improved enuresis (RR: 2.34; 95% CI: 1.05-5.20). Additionally, a subset of 17 patients with vesicoureteral reflux (VUR) was evaluated. Among those who underwent EMGBF, VUR resolution was observed in all but one patient with grade IV reflux. Reported resolution rates were 88.8% at 6 months and 77.7% at 1 year in the intervention group, compared with 37.5% and 12.5%, respectively, in the control group. However, these findings should be interpreted with caution given the limited number of patients and lack of randomization for VUR-specific outcomes.</p><p><strong>Conclusion: </strong>EMGBF is an effective and well-tolerated intervention for treating dysfunctional voiding in children and adolescents. Benefits include improvements in urinary symptoms, urodynamic parameters, and infection rates. 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引用次数: 0
摘要
目的：通过综合随机对照试验的证据，评价肌电生物反馈（EMG-BF）治疗儿童和青少年排尿功能障碍（DV）的疗效。方法：我们对评估肌电- bf治疗诊断为DV的儿科患者的随机对照试验进行了系统回顾和荟萃分析。截至2025年1月，在七个数据库（Cochrane Central Register of Controlled Trials, PubMed/MEDLINE， EMBASE, Scopus, Web of Science， Livivo和LILACS）中进行了检索。灰色文献也使用谷歌Scholar、ProQuest和medRxiv进行检索。结果：纳入4项随机对照试验，共244例患者。荟萃分析显示肌电- bf治疗显著增加最大尿流率（MD: 4.69; 95% CI: 1.06-8.31），排尿流模式正常化（RR: 2.70; 95% CI: 1.43-5.10），减少空后残留尿（MD: 11.11; 95% CI: 2.38-19.84），改善遗尿（RR: 2.34; 95% CI: 1.05-5.20）。此外，对17例膀胱输尿管反流（VUR）患者进行了评估。在接受肌电- bf检查的患者中，除1例IV级反流患者外，其余患者均有VUR消退。干预组6个月和1年的治愈率分别为88.8%和77.7%，对照组分别为37.5%和12.5%。然而，考虑到有限的患者数量和缺乏vur特异性结果的随机化，这些发现应该谨慎解释。结论：肌电- bf是治疗儿童和青少年排尿功能障碍的有效且耐受性良好的干预手段。其益处包括改善泌尿系统症状、尿动力学参数和感染率。虽然初步研究结果表明对VUR可能有积极作用，但需要进一步的高质量试验来证实这些观察结果并优化治疗方案。
Efficacy of Electromyographic Biofeedback for Dysfunctional Voiding in Children and Adolescents: A Systematic Review and Meta-analysis of Randomized Trials.
Objective: To assess the efficacy of electromyographic biofeedback (EMGBF) in the treatment of dysfunctional voiding (DV) in children and adolescents by synthesizing evidence from randomized controlled trials.
Methods: We conducted a systematic review and meta-analysis of randomized and controlled trials evaluating EMGBF therapy in pediatric patients diagnosed with DV. Searches were performed across seven databases (Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Livivo, and LILACS) up to January 2025. Gray literature was also searched using Google Scholar, ProQuest, and medRxiv.
Results: Four randomized controlled trials were included, totaling 244 patients. The meta-analysis showed that EMGBF therapy significantly increased maximum urinary flow rate (MD: 4.69; 95% CI: 1.06-8.31), normalized voiding flow patterns (RR: 2.70; 95% CI: 1.43-5.10), reduced postvoid residual urine (MD: 11.11; 95% CI: 2.38-19.84), and improved enuresis (RR: 2.34; 95% CI: 1.05-5.20). Additionally, a subset of 17 patients with vesicoureteral reflux (VUR) was evaluated. Among those who underwent EMGBF, VUR resolution was observed in all but one patient with grade IV reflux. Reported resolution rates were 88.8% at 6 months and 77.7% at 1 year in the intervention group, compared with 37.5% and 12.5%, respectively, in the control group. However, these findings should be interpreted with caution given the limited number of patients and lack of randomization for VUR-specific outcomes.
Conclusion: EMGBF is an effective and well-tolerated intervention for treating dysfunctional voiding in children and adolescents. Benefits include improvements in urinary symptoms, urodynamic parameters, and infection rates. Although preliminary findings suggest a possible positive effect on VUR, further high-quality trials are warranted to confirm these observations and to optimize therapeutic protocols.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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