Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

ABSTRACT Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.

Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

OBJECTIVE: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. PATIENTS AND METHODS: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry - electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry - EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. RESULTS: A total of forty - five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 - 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). CONCLUSIONS: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post - void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.

Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia.

OBJECTIVES: To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. METHODS: We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. RESULTS: Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57-85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45-84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). CONCLUSION: PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.

Can a four-session biofeedback regimen be used effectively for treating children with dysfunctional voiding?

OBJECTIVE: To compare the outcomes of the open-ended six to ten sessions of biofeedback against a novel regime of four sessions of biofeedback to treat children with dysfunctional voiding. MATERIALS AND METHODS: Patients from two centers using different methods were retrospectively analyzed. Group 1 comprised 20 patients treated with four sessions of biofeedback. Group 2 comprised 20 patients treated with six to ten sessions of biofeedback. Each group was evaluated with subjective and objective parameters pre-treatment, immediately post-treatment and 6 months post-treatment. RESULTS: All patients in Group 1 were treated with four sessions of biofeedback and in Group 2 the mean number of sessions was 7.35±1.30 (range 6-10). Normalized voiding flow curves after treatment were determined in 18 patients in Group 1 (90%) and 19 patients in Group 2 (95%) (p=0.553). There were seven patients (35%) in Group 1 and eight patients (40%) in Group 2 with reflux. When units were compared, there were 11 units (4 bilateral) in Group 1 and 13 units (5 bilateral) in Group 2 with reflux (p=0.747). At 6 months post-treatment, in Group 1, seven had resolved (63.6%), three had improved (27.2%) and one persisted (9.01%). In Group 2, ten had resolved (76.9%) and three had improved (23.1%) (p=0.553). CONCLUSIONS: Biofeedback therapy is one of the most widely used techniques in dysfunctional voiding in children. The regime of use has not been well defined, and the results of this study showed that a regime of four sessions of biofeedback therapy may be as safe and effective as the previously defined open-ended six to ten sessions.