Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Çocuklarda Tedaviye Dirençli Disfonksiyonel İşemede Biofeedback Tedavisinin Etkinliği: Retrospektif Kohort Araştırması
Efficacy of Biofeedback Therapy in the Treatment-Resistant Dysfunctional Voiding in Children: Retrospective Cohort Study
Burak ÖZÇİFTa
aSağlık Bilimleri Üniversitesi İzmir Dr. Behçet Uz Çocuk Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Çocuk Ürolojisi Kliniği, İzmir, Türkiye
J Reconstr Urol. 2022;12(3):129-34
doi: 10.5336/urology.2021-87922
Article Language: TR
Full Text
ÖZET
 Amaç: Disfonksiyonel işeme, idrar kaçırma sorunu olan çocukların %30'u kadarında bulunabilen yaygın bir sorundur. Biofeedback, disfonksiyonel işemeyi tedavi etmek için farmakolojik olmayan ve invaziv olmayan bir yöntemdir. Bu çalışmanın amacı, tedaviye dirençli aşırı aktif mesane+disfonksiyonel işemesi olan ve sadece disfonksiyonel işemesi olan çocuklarda biofeedback tedavisinin etkinliğini değerlendirmek ve karşılaştırmaktır. Gereç ve Yöntemler: Bu çalışmaya, Haziran 2017-Ağustos 2020 tarihleri arasında disfonksiyonel işemesi olan, standart üroterapiye yanıt vermeyen çocuklar dâhil edildi. Tüm hastalara 8 seans biofeedback tedavisinin ardından, evde 3 aylık pelvik taban kas egzersizi uygulandı. Hastaların biofeedback öncesi ve biofeedbackten 3 ay sonrası semptomları, üroflovmetri parametreleri ve tedaviye yanıt oranları karşılaştırıldı. Bulgular: Elli beş çocuk (ortalama yaş 9,60±2,90 yıl, 41 kız, 14 erkek) çalışmaya dâhil edildi. Aşırı aktif mesane+disfonksiyonel işemesi olan hastalarda idrar yolu enfeksiyonları, gece ve gündüz inkontinans, kesintili işeme, kabızlık, işeme hacmi, maksimum akış hızı, ortalama akış hızı, işeme süresi ve işeme sonrası kalıntı idrarda iyileşme görüldü (p<0,05). Sadece disfonksiyonel işemesi olan çocuklarda idrar yolu enfeksiyonları, kesintili işeme, kabızlık, maksimum akış hızı, ortalama akış hızı ve işeme sonrası kalıntı idrarda iyileşme görüldü (p<0,05). Genel olarak, sadece disfonksiyonel işemesi olan hastalarda biofeedback tedavisine daha iyi yanıt gözlendi (%77,8'e karşı %53,6). Sonuç: Tedaviye dirençli aşırı aktif mesane+disfonksiyonel işeme ve sadece disfonksiyonel işemesi olan çocuklarda biofeedback etkili bir tedavi yöntem olup, tatmin edici yanıt elde edilmektedir. Bununla birlikte, sadece disfonksiyonel işemesi olan hastalarda daha iyi tedavi yanıtı alınmaktadır.

Anahtar Kelimeler: Biofeedback; çocuk; disfonksiyonel işeme; aşırı aktif mesane; üroflovmetri
ABSTRACT
 Objective: Dysfunctional voiding is a common problem that can be found in up to 30% of children with urinary incontinence. Biofeedback is a non-pharmacological and non-invasive method for treating dysfunctional voiding. The aim of this study was to evaluate and compare the effectiveness of biofeedback treatment in children with treatment-resistant overactive bladder+dysfunctional voiding and only dysfunctional voiding. Material and Methods: Children with dysfunctional voiding who did not respond to standard urotherapy between June 2017-August 2020 were included in this study. After 8 sessions of biofeedback treatment in all patients, 3 months of pelvic floor muscle exercise was performed at home. The patients' symptoms, uroflowmetry parameters, and response rates to treatment were compared before and 3 months after biofeedback. Results: Fifty-five children (mean age 9.60±2.90 years, 41 girls, 14 boys) were included in the study. Patients with overactive bladder+dysfunctional voiding showed improvement in urinary tract infections, day and night incontinence, staccato voiding, constipation, voiding volume, maximum flow rate, average flow rate, voiding time, and postvoiding residue (p<0.05). Children with only dysfunctional voiding showed improvement in urinary tract infections, staccato voiding, constipation, maximum flow rate, average flow rate, postvoiding residue (p<0.05). Overall, better response to biofeedback treatment was observed in patients with only dysfunctional voiding (77.8% vs. 53.6%). Conclusion: Biofeedback is an effective treatment modality in children with treatment-resistant overactive bladder+dysfunctional voiding and only dysfunctional voiding, with satisfactory treatment response. However, only patients with dysfunctional voiding have better treatment response.

Keywords: Biofeedback; child; dysfunctional voiding; overactive bladder; uroflowmetry
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