BACKGROUND: Pelvic floor physical therapy (PFPT) is a well-established treatment modality for pediatric dysfunctional voiding. However, its utilization and effectiveness are poorly described. We seek to report on the efficacy of PFPT in a large cohort of children with dysfunctional voiding.
METHODS: We performed a single institution, retrospective review of all patients at our institution referred for PFPT from Nov 2021 to March 2024. Covariates included demographics (age, referring program/specialty, compliance with PFPT), PFPT characteristics (number of sessions, type of exercises, compliance with PFMT, uroflow patterns), and outcomes (symptomatic improvement/worsening as determined by physical therapist or urologists).
RESULTS: In total, 181 patients were included after excluding those were loss of follow-up (n=211), with only single PFPT session (n=45), bladder exstrophy (n=5), neurogenic bladder on CIC (n=5), and non-urologic indications for referral (e.g. bowel-only complaints, n=115). The majority (94%) were referred by the urology department. The mean age was 10.8±4.6 years. Median follow-up time was 13 months (IQR 8-18 months). All but one patient had both lengthening and strengthening exercises (please see Table 1 for the list of exercises). Most (93%) had simultaneous biofeedback with PFPT. The median number of PFPT sessions was 5 (IQR 4-8). Forty-two patients (23%) reported complete resolution of symptoms and did not require further PFPT. Among those, one patient experienced relapse of symptoms and returned for further evaluation and treatment 6 months after resolution. The majority of the remaining patients (74%) reported improvement and 3% reported no difference between pre- and post-PFMT . There was no significant difference in terms of number of total sessions between those who were cured or not (p=0.21).
CONCLUSION: Pelvic floor physical therapy has a positive clinical impact on dysfunctional voiding in pediatric patients. Our data are limited by shorter time span and unclear outcome for those who lost to follow up and did not complete the PFPT sessions. Future studies that include more precise selection criteria and more granular phenotype would help identify which patients would benefit from PFPT.
