Animated biofeedback yields more rapid results than nonanimated biofeedback in the treatment of dysfunctional voiding in girls

Purpose: Biofeedback is known to effect symptomatic and objective cure in children with dysfunctional voiding. While some authors advocate animation assisted biofeedback to achieve success, we previously demonstrated similar success without animation. We recently used animated biofeedback aimed at simplifying muscle isolation and encouraging patient interest. We compared the efficacy of biofeedback with and without animation in treating dysfunctional voiding, and its concomitant urinary symptoms. Materials and Methods: We compared our experience with the last 60 cases of biofeedback using electromyography tracing alone (nonanimated) with our first 60 cases using the Urostym (TM) Pediflow program (animated). All 120 girls presented with urinary complaints and exhibited dysfunctional voiding on electromyography uroflow. Post-void residual measurements were made by ultrasound. We compared the 2 groups with respect to time to resolution of symptoms and dysfunctional voiding, and improvement in post-void residual volume after treatment. Results: The nonanimated and animated groups were comprised of girls of similar ages (7.3 years vs 6.9 years). There was no significant difference between the 2 groups regarding symptom relief at a mean of 5.4 months after therapy, including daytime incontinence, nocturnal enuresis, urgency, frequency and hoarding. Three patients in each group experienced urinary tract infection following treatment, compared to 42 and 41 before treatment in the nonanimated and animated groups, respectively. Dysfunctional voiding resolved in 95% of patients in both groups. Post-void residual reduction was similar, namely from 35% to 9% of pre-void volume in the nonanimated group, and from 28% to 8% in the animated group. Children in the animated biofeedback group achieved success in significantly fewer sessions (3.6) than those undergoing nonanimated biofeedback (7.6, t test p < 0.05). Conclusions: Despite our proved experience with nonanimated biofeedback systems and our inexperience with an animated system, animated biofeedback systems yielded similar results in a significantly shorter time. Animated and nonanimated biofeedback is efficacious in the treatment of dysfunctional voiding and its symptoms.