Biofeedback therapy and home pelvic floor exercises for lower urinary tract dysfunction after posterior urethral valve ablation

Abstract

Purpose: We sought to determine the effectiveness of biofeedback therapy and home pelvic floor exercises in children presenting with lower urinary tract dysfunction after posterior urethral valve ablation.

Materials and methods: Children with urodynamically proved lower urinary tract dysfunction after successful valve ablation were enrolled for biofeedback therapy and home pelvic floor exercises. Detrusor pressure and electromyography findings were visually conveyed to patients on the computer screen. Patients were instructed to interrupt detrusor pressure increments by tensing the pelvic floor musculature in the presence of detrusor overactivity. In the presence of the nonrelaxing pelvic floor patients were first instructed to tighten the pelvic floor musculature and then to relax.

Results: A total of 30 children were enrolled for biofeedback therapy and home pelvic floor exercises between October 2005 and December 2006. Median patient age at first session was 5.1 years (range 4.5 to 12). Three patients (10%) had an excellent response, and 18 (60%) had a good response, with an overall consistent response of 70%. Nine patients (30%) had an inconsistent response. Mean number of sessions to achieve consistent urodynamic response was 3.5 (range 2 to 7). Mean baseline cystometric bladder capacity was 65% of normal for age (range 45% to 80%), which improved to a mean of 87.25% (50% to 100%) after treatment (p = 0.001). Of the 21 children who had a consistent response 11 (52%) do not require any further anticholinergics and 15 (71%) are free of clean intermittent catheterization. At a mean followup of 11 months (range 5 to 18) none of the patients had relapse.

Conclusions: Biofeedback therapy and home pelvic floor exercises provide significant and durable relief in post-valve ablation persistent lower urinary tract dysfunction.