The evaluation of combined standard urotherapy, abdominal and pelvic floor retraining in children with dysfunctional voiding.
PURPOSE
The aim of the study was to compare the treatment outcome of two urotherapy programs in children with dysfunctional voiding (DV) through analyzing the clinical manifestations and uroflowmetry parameters.


MATERIALS AND METHODS
Eighty-six children with DV were randomly divided into two groups (A and B). Children in both groups were educated about the importance of regular voiding and hydratation, and about the appropriate posture during voiding. Simple voiding instructions were provided. In group A diaphragmatic breathing and pelvic floor muscles (PFM) retraining were additionally assigned to children. Constipation and recurrent urinary tract infections (UTIs) were treated in both groups. Selected children from both groups received pharmacotherapy (anticholinergics or desmopressin). Uroflowmetry with pelvic floor electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period.


RESULTS
After one year of therapy, urinary incontinence and nocturnal enuresis were cured in a significantly larger number of children in group A than in group B (P < 0.001; P < 0.05). Although more children with UTIs were cured in group A, the difference was not statistically significant compared to group B. There was a significant recovery constipation-wise in both groups. Post-treatment uroflowmetry parameters and curve pattern were markedly improved only in group A.


CONCLUSIONS
Carefully planned and regularly controlled abdominal and PFM retraining is beneficial in children with DV for curing urinary incontinence, nocturnal enuresis, UTIs and normalizing urinary function. Further trials are needed to define the most effective treatment program for achieving the best treatment outcome.