The effects of pelvic floor muscle therapy on symptoms, voiding, and pelvic floor muscle activity parameters in children with overactive bladder.

INTRODUCTION: Refractory overactive bladder (OAB) in children can be treated with second line modalities such as as biofeedback, transcutaneous electrical stimulation (TENS), and botulinum toxin. In this study, we aimed to investigate the efficacy of biofeedback-assisted pelvic floor muscle therapy (PFMT) on symptoms, bladder capacity, uroflowmetry, and pelvic floor muscle activity (PFMA) in children with resistant OAB or dysfunctional voiding (DV) with associated seconder bladder overactivity (DV/SBO). MATERIALS AND METHODS: A total of 24 children with resistant OAB were included in the study. Patients were divided into two groups as: group-1 pure OAB and group-2 DV/SBO. Children were evaluated with voiding diary, uroflowmetry-EMG, PFMA before and after treatment. All patients were treated with PFMT. RESULTS: Urgency cured or improved in 12 of 17 (71%) of children in group-1 and in six of seven (86%) children in group-2 (P < 0.0001 and 0.031, respectively). Other symptoms cured or improved with 64%-100% recovery rates in group-1 and 50%-80% in group-2. Maximum voided volume (maxVV) in voiding diary increased from 81.6 to 150.9 mL in group-1 and from 115.6 to 175.7 mL in group-2 (P < 0.0001 and 0.063, respectively). Mean work value of PFMA increased and mean rest value of PFMA decreased significantly (P < 0.0001, 0.018 and P = 0.002 and 0.018, respectively). CONCLUSION: The measurement of PFMA in children with refractory OAB or DV/SBO gives information on the strength and endurance of PFMs. In children with refractory OAB or DV/SBO, biofeedback-assisted PFMT provides symptomatic improvement and increases functional bladder capacity.

Biofeedback as a first-line treatment for overactive bladder syndrome refractory to standard urotherapy in children.

INTRODUCTION: Overactive bladder syndrome (OAB) and dysfunctional voiding (DV) are subgroups of lower urinary tract dysfunction (LUTD). Standard urotherapy is the first-line treatment option of OAB in children. OBJECTIVES: The aim was to investigate the use of biofeedback as a first-line treatment option in OAB refractory to standard urotherapy, and determine the factors affecting efficacy. STUDY DESIGN: Between 2005 and 2015, we retrospectively analyzed a total of 136 hospital records of children with OAB who had not previously used any anticholinergics and were refractory to standard urotherapy. Patients with urgency and/or urge incontinence and/or making holding maneuvers to suppress urgency were defined as having OAB symptoms, and resolution of these complaints was defined as successful biofeedback therapy. RESULTS: Seventy-three of 136 OAB patients' urgency recovered by biofeedback therapy with the success rate of 53% (p < 0.001). Sixty-two of 101 patients with holding maneuvers (success rate 61%) (p < 0.001), 70 of 101 patients with urgency incontinence (success rate 69%) (p < 0.001), 76 of 114 patients with daytime incontinence (success rate 66%) (p = 0.023), 87 of 97 patients with enuresis (success rate 89%) (p = 0.009), and 27 of 39 patients with dysuria (success rate 69%) (p = 0.007) recovered from their symptoms significantly. The mean lower urinary tract symptom score (LUTSS) was 16.38 and 8.18 before and after biofeedback therapies, respectively (p < 0.001) (Table). Patients without holding maneuvers (p = 0.045), daytime incontinence (p = 0.030), and enuresis (p = 0.045) had better recovery compared to the opposites. DISCUSSION: Biofeedback can be thought of as the first-line treatment option when standard urotherapy fails in children with OAB.

The biofeedback treatment for non-monosymptomatic enuresis nocturna.

AIMS: Enuresis is a child older than 5 years wetting in discrete portions during sleep. It has two subgroups: monosymptomatic enuresis nocturna (MSEN) and non-monosymptomatic enuresis nocturna (NMSEN). In this research, we specifically aimed to examine the effect of biofeedback in NMSEN. METHODS: We retrospectively analyzed the hospital records of 182 children with NMSEN who were refractory to urotherapy modifications and directed to biofeedback therapies between 2005 and 2010. Enuresis before and after biofeedback therapies was evaluated. One or less enuretic night in a month was defined as success. RESULTS: There were 118 (64%) girls and 64 (35%) boys. With biofeedback therapy, 117 of 182 patients recovered with a success rate of 64% (P < 0.001), but 65 patients still had enuresis. Seventy-two out of 118 girls recovered with a success rate of 61% (P < 0.001), whereas 45 out of 64 boys recovered with a success rate of 70% (P = 0.001). The NMSEN complaints of daytime incontinence, dysuria, urgency, holding maneuvers, and urgency incontinence disappeared significantly concomitant to the enuresis component, as well (P < 0.05). CONCLUSIONS: Biofeedback therapy is an effective treatment option for the enuresis component of NMSEN with a 64% success rate.

Hyperbaric oxygen treatment for unilateral testicular torsion in a child.

Torsion of the testis is a urological emergency most commonly occurring in adolescent boys. Hyperbaric oxygen treatment (HBOT) has been shown to alleviate reperfusion injury in experimental ischaemia of the testis. We report a 13-year-old boy who had prolonged right testicular ischaemia. Despite surgery, the colour of the testis remained poor. He underwent a post-operative course of 10 HBOT over 8 days, with restoration of blood flow on colour Doppler and reduction of oedema. At four-month followup, the testis appeared normal on ultrasonography. To the best of our knowledge, this is the first published case of torsion of the testis treated with HBOT.

Urethral stripping caused by stent removal and its successful treatment with hyperbaric oxygen therapy: a case report.

Urethral stents usually provide initial, dramatic relief from obstructive voiding symptoms. However, complications such as recurrent urinary tract infections, stent migration, encrustation and recurrent urethral strictures are not rare, and stents should be removed when complications occur. Urethral stent removal is associated with potential risks of urethral injury, bleeding and external sphincter trauma. Hyperbaric oxygen therapy (HBO) accelerates wound healing by increasing tissue microcirculation, decreasing capillary pressure and resolving tissue edema. Although HBO has been used in various urologic applications, there is no report of HBO therapy being used to treat isolated urethral injuries. Here we present a case of urethral stripping caused by endoscopic stent removal, and its conservative treatment with HBO therapy.