NEW YORK (Reuters Health) - Biofeedback improves urodynamic parameters in pediatric patients with bladder dysfunction, Turkish researchers report, and can even be helpful for children as young as 5.

Urinary problems often are due to dysfunctional contraction of the pelvic floor muscles, which interferes with normal bladder function, Dr. Sezgin Yagci of Gulhane Military Medical Academy in Ankara and colleagues note. Biofeedback techniques are an accepted treatment approach for pediatric patients with voiding problems of this type, they point out in the November issue of the Journal of Urology.

In the current study, Dr. Yagci and his team evaluated biofeedback training in a group of 188 children with voiding problems, using a system that allowed for recording and visual display of urine flow and electromyography activity. Children were instructed to contract and relax the urinary sphincter several times. A visual display represented the muscle activity, with a column of light that changed lengths as the muscles contracted and relaxed.

The children, who ranged in age from 5 to 14 years, underwent the training weekly, and were told to perform the exercises themselves at home. Sessions were scheduled every three to four weeks once the children understood the concept of biofeedback training and exercising at home regularly. The training lasted for a total of six months.

The researchers evaluated the children at six months and two years after the completion of training.

All but 20 of the original group completed the study. All parameters, which included both subjective and objective measures, showed improvement at six months.

For example, 81% showed a 90% improvement in nocturnal enuresis as reported by their parents, while 59.2% of patients with daytime wetting showed the same degree of improvement. Recurrent urinary tract infections improved in 85% of patients, while bladder overactivity improved in 80.4% of patients.

At two years, the rate of improvement for several parameters, including nocturnal enuresis and urinary tract infection, had increased, while for others, including daytime wetting, it decreased.

"Biofeedback training is a simple, effective and well-tolerated treatment modality in children for various parameters resulting from bladder dysfunction," the researchers conclude, noting that it is important to select patients -- and parents -- who are motivated to participate in the training.

J Urol 2005;174:1994-1998

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