The Effectiveness of Biofeedback Therapy in Treating Dysfunctional Voiding and Enuresis in Children: A Retrospective Study

INTRODUCTION: Biofeedback therapy is a non-invasive approach used to treat children with dysfunctional voiding (DV) and daytime enuresis (DE). It improves voluntary relaxation of the pelvic floor muscles and normalizes voiding patterns. This study aimed to evaluate clinical indications, treatment responses, and changes in uroflowmetry parameters and voiding curve patterns in children receiving biofeedback therapy.
METHODS: This retrospective study included children aged 5–18 years with DV or DE who underwent at least two pre-treatment uroflowmetry (UFM) and electromyography (EMG) evaluations between April 2023 and March 2024. A standardized biofeedback protocol was administered weekly by a trained nurse under the supervision of a pediatric urologist. Voiding symptoms, EMG activity, and uroflowmetry parameters were assessed. McNemar and Wilcoxon signed-rank tests were used for statistical analysis.
RESULTS: A total of 42 female patients (mean age: 12±3.2 years) were evaluated. Non-monosymptomatic enuresis (31%) and DV-related urinary tract infections (24%) were the most common indications. Daytime incontinence was present in 33% of patients, and 62% had a history of urinary tract infections. Although complete response rates were low, improvements were observed in EMG relaxation (83%) and bell-shaped voiding curves, which increased markedly from 26.3% to 84% by the 8th session. Voided volume and Qmax increased significantly (p<0.05). Children with ≥5 voids per day showed a significantly higher treatment response (p=0.031).
DISCUSSION AND CONCLUSION: Biofeedback therapy effectively improves voiding parameters and pelvic floor muscle relaxation; however, complete dryness remains limited, particularly in patients with nocturnal enuresis.

Keywords: Biofeedback, dysfunctional voiding, EMG activity, enuresis, urinary patterns