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Article Abstract
Objective: To assess the efficacy of electromyographic biofeedback (EMG-BF) in the treatment of dysfunctional voiding (DV) in children and adolescents by synthesizing evidence from randomized controlled trials.
Methods: We conducted a systematic review and meta-analysis of randomized and controlled trials evaluating EMG-BF therapy in pediatric patients diagnosed with DV. Searches were performed across seven databases (Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Livivo, and LILACS) up to January 2025. Grey literature was also searched using Google Scholar, ProQuest, and medRxiv.
Results: Four randomized controlled trials were included, totaling 244 patients. The meta-analysis showed that EMG-BF therapy significantly increased maximum urinary flow rate (MD: 4.69; 95% CI: 1.06-8.31), normalized voiding flow patterns (RR: 2.70; 95% CI: 1.43-5.10), reduced post-void residual urine (MD: 11.11; 95% CI: 2.38-19.84), and improved enuresis (RR: 2.34; 95% CI: 1.05-5.20). Additionally, a subset of 17 patients with vesicoureteral reflux (VUR) was evaluated. Among those who underwent EMG-BF, VUR resolution was observed in all but one patient with grade IV reflux. Reported resolution rates were 88.8% at six months and 77.7% at one year in the intervention group, compared with 37.5% and 12.5%, respectively, in the control group. However, these findings should be interpreted with caution given the limited number of patients and lack of randomization for VUR-specific outcomes.
Conclusions: EMG-BF is an effective and well-tolerated intervention for treating dysfunctional voiding in children and adolescents. Benefits include improvements in urinary symptoms, urodynamic parameters, and infection rates. Although preliminary findings suggest a possible positive effect on VUR, further high-quality trials are warranted to confirm these observations and to optimize therapeutic protocols.
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| http://dx.doi.org/10.1016/j.urology.2025.08.046 | DOI Listing |
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