The incidence,spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service

IntroductionThe purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries.MethodsThe Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014.ResultsOf 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service.ConclusionTraumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries.     

医源性输尿管损伤并发上尿路梗阻的外科治疗策略

目的：研究医源性输尿管损伤后并发上尿路梗阻的病理基础。探讨处理医源性输尿管损伤后梗阻的外科治疗策略。方法：回顾性分析自2007年2月～2009年4月,上海交通大学医学院附属仁济医院泌尿外科诊治的16例输尿管腔内操作致医源性输尿管损伤并发上尿路梗阻的患者。患者平均年龄49岁。所有患者输尿管损伤后均曾成功留置D-J管4～6周。就诊时平均术后时间9．8个月（3～18个月）。通过磁共振水成像（MRU）评价输尿管梗阻累及部位、梗阻段长度及输尿管瘢痕组织厚度。以STORZF7.9。输尿管镜检查患侧输尿管。对于患侧输尿管管腔通畅者行开放输尿管梗阻段切除术,并对该段输尿管行病理检查。对于输尿管镜证实受累输尿管存在机械性梗阻,狭窄段长度〈2cm的患者行输尿管镜下钬激光输尿管内切开术。所有患者术后留置D-J管6周。术后6个月以静脉尿路造影（IVu）评价手术效果。结果：在4例患者中,STORZF7.9。输尿管硬镜成功进镜至肾盂,未发现患侧输尿管机械性梗阻。予切除瘢痕增生段输尿管,病理检查提示输尿管全层增厚伴慢性炎症,纤维组织增生,平滑肌细胞排列杂乱,但黏膜层尿路上皮完整且无明显增生。另12例患者经输尿管硬镜检查证实机械性梗阻存在,行钬激光输尿管内切开术。术后6个月随访显示,4例行开放手术患者均未出现输尿管再狭窄。12例行输尿管钬激光内切开患者中3例上尿路梗阻复发。行狭窄段切除,6个月后随访见上尿路积水消失。结论：在部分输尿管损伤后上尿路梗阻的患者,其输尿管管腔通畅,动力性梗阻可能占主导地位。对于这些患者外科手术切除输尿管狭窄段可能是最佳选择。输尿管腔内钬激光内切开术适用于狭窄段较短（〈2cm）且不伴严重输尿管增厚的患者,但远期复发率较高。尿外渗是加重输尿管损伤后纤维瘢痕形成的重要因素,在合并严重尿外渗的患者中,经皮肾穿刺（PCN）引流可能减轻局部纤维瘢痕反应,改善患者预后。     

Management of a hypoplastic lower urinary tract: a case report

This case relates to a child with an antenatal diagnosis of severe bilateral hydronephrosis with congenital anomalies of the ureters, bladder, and urethra. We describe the presentation and surgical management, highlighting the complexity of this anomaly and the surgical technique used to reconstruct the lower urinary tract. To our knowledge, there has not been a similar case in the literature and the use of a segment of colon for ureteric substitution in children has not been previously reported in the literature.     

Management of traumatic brain injury: a narrative review of current evidence

Globally, approximately 70 million people sustain traumatic brain injury each year and this can have significant physical, psychosocial and economic consequences for patients, their families and society. The aim of this review is to provide clinicians with a summary of recent studies of direct relevance to the management of traumatic brain injury in order to promote best clinical practice. The use of tranexamic acid in the management of traumatic brain injury has been the focus of several studies, with one large randomised controlled trial suggesting a reduction in all-cause mortality within 24 h of injury. The use of therapeutic hypothermia does not improve neurological outcomes and maintenance of normothermia remains the optimal management strategy. For seizure management, levetiracetam appears to be as effective as phenytoin, but the optimal dose remains unclear. There has been a lack of clear outcome benefit for any individual osmotherapy agent, with no difference in mortality or neurological recovery. Early tracheostomy (< 7 days from injury) for patients with traumatic brain injury is associated with a reduction in the incidence of ventilator-associated pneumonia and duration of mechanical ventilation, critical care and hospital stay. Further research is needed in order to determine the optimal package of care and interventions. There is a need for research studies to focus on patient-centred outcome measures such as long-term neurological recovery and quality of life.     

Transection of the stomach after blunt injury in the pediatric population

The incidence of gastric rupture after abdominal blunt injury ranges between 0.02% and 1.7% and is associated with a high morbidity (Tejerina Alvarez EE, Holanda MS, Lopex-Espadas F, Dominguez MJ, Ots E, Diaz-Reganon J. Gastric rupture from blunt abdominal trauma. Injury. 2004;35:228-231, Allen GS, Moore FA, Cox CS. Hollow visceral injury and blunt trauma. J Trauma. 1998;45:69-75.). Stomach transection represents an even rarer type of blunt gastric injury. Although not specifically included in the accepted classification of stomach injury, its clinical manifestation is dramatic, requiring immediate surgical management. We present a case report from our institution and reviewed the international literature focusing on the pediatric patient to illustrate this injury in terms of mechanism of injury, clinical presentation, and surgical management.     

Updated APSA Guidelines for the Management of Blunt Liver and Spleen Injuries

BackgroundNon-operative management of blunt liver and spleen injuries was championed initially in children with the first management guideline published in 2000 by the American Pediatric Surgical Association (APSA). Multiple articles have expanded on the original guidelines and additional therapy has been investigated to improve care for these patients. Based on a literature review and current consensus, the management guidelines for the treatment of blunt liver and spleen injuries are presented.MethodsA recent literature review by the APSA Outcomes committee [2] was utilized as the basis for the guideline recommendations. A task force was assembled from the APSA Committee on Trauma to review the original guidelines, the literature reported by the Outcomes Committee and then to develop an easy to implement guideline.ResultsThe updated guidelines for the management of blunt liver and spleen injuries are divided into 4 sections: Admission, Procedures, Set Free and Aftercare. Admission to the intensive care unit is based on abnormal vital signs after resuscitation with stable patients admitted to the ward with minimal restrictions. Procedure recommendations include transfusions for low hemoglobin (<7 mg/dL) or signs of ongoing bleeding. Angioembolization and operative exploration is limited to those patients with clinical signs of continued bleeding after resuscitation. Discharge is based on clinical condition and not grade of injury. Activity restrictions remain the same while follow-up imaging is only indicated for symptomatic patients.ConclusionThe updated APSA guidelines for the management of blunt liver and spleen injuries present an easy-to-follow management strategy for children.Level of EvidenceLevel 5.     

Recent changes in the management of blunt splenic injury: effect on splenic trauma patients and hospital implications

INTRODUCTION

Management of blunt splenic injury has been controversial with an increasing trend towards splenic conservation. A retrospective study was performed to identify the effect of this changed policy on splenic trauma patients and its implications.

PATIENTS AND METHODS

Data regarding patient demography, mode of splenic injury, CT grading, blood transfusion requirement, operative findings hospital stay and follow-up were collected. Statistical analysis of the data was performed using non-parametric Mann–Whitney tests

RESULTS

Over an 8-year period, only 21 patients were admitted with blunt splenic injury. Ten patients were managed operatively and 11 non-operatively. Non-operative management failed in one patient due to continued bleeding. Using Buntain''s CT grading, the majority of grades I and II splenic injuries were managed non-operatively and grades III and IV were managed operatively (P = 0.008). Blood transfusion requirement was significantly higher among the operative group (P = 0.004) but the non-operative group had a significantly longer hospital stay (P = 0.029). Among those managed non-operatively (median age, 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown long-term consequences.

CONCLUSIONS

Non-operative management of blunt splenic trauma in adults can be performed with an acceptable outcome. Although CT is classed as the ‘gold standard’, initial imaging for detection and evaluation of blunt splenic injury, ultrasound can play a major role in follow-up imaging and potentially avoids major radiation exposure.     

MANAGEMENT OF VESICO-URETERIC REFLUX IN MYELODYSPLASIA NEUROGENIC BLADDER

During the period 1978–87, 22 patients with myelodysplasia had surgery for vesico-ureteric reflux (VUR) and seven patients with VUR were managed non-operatively. Clean intermittent catheterization was an integral part of the management in both the operated and non-operated cases. The majority of patients had reflux-related upper tract changes pre-operatively. but alter operation the urinary tract was stabilized in all but one kidney which was lost. Tranverse advancement ureteric reimplantation or the pull-through technique provided satisfactory results, giving a total of 29 refluxing units managed surgically.     

Pelvic fracture‐related injuries of the bladder neck and prostate: their nature,cause and management

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To report our experience of bladder neck injuries, which are a well recognized but rare consequence of pelvic fracture‐related trauma to the lower urinary tract, as we have been unable to find any reference in the English literature to their specific nature, cause and management in adults.

PATIENTS AND METHODS

In the last 10 years we have treated 15 men with bladder neck injuries after pelvic fracture. Two were treated at our centre by delayed primary repair. Thirteen were initially treated elsewhere and presented to us 3 months to 5 years after their injury with intractable incontinence and various other symptoms most notably recurrent urinary infection and gross haematuria. Twelve of the injuries were at or close to the anterior midline and associated with lateral compression fractures or ‘open‐book’ injuries. Five of them were confined to the bladder neck and prostatic urethra; the other seven extended into the subprostatic urethra. Four of these were associated with a coincidental typical rupture of the posterior urethra. All had an associated cavity involving the anterior disruption of the pelvic ring. Two of the injuries, following particularly severe trauma, were a simultaneous complete transection of the bladder neck and of the bulbo‐membranous urethra with a sequestered prostate between. We have seen this in children before but not in adults. Another injury, also after particularly severe trauma, was an avulsion of the anterior aspect of the prostate. We have not seen this described before. Fourteen patients underwent lower urinary tract reconstruction and one underwent a Mitrofanoff procedure. All of the 14 had a layered reconstruction of the prostate and bladder neck and in 13, this was supplemented with an omental wrap.

RESULTS

In all patients with an anterior midline rupture, the primary injury appeared to be to the prostate and prostatic urethra with secondary involvement of the bladder neck and the subprostatic urethra. The Mitrofanoff procedure was successful. Of the 14 patients with a layered reconstruction one, without an omental wrap, broke down but was successfully repaired on a subsequent occasion. The four patients who also had a ruptured urethra had a simultaneous bulbo‐prostatic anastomotic urethroplasty, two of which required further attention. Eight of the 14 reconstructed patients underwent implantation of an artificial urinary sphincter (AUS) for sphincter weakness incontinence, in seven of whom this was successful. Two of these had previously undergone implantation of an AUS with an unsatisfactory outcome and were made continent by bladder neck reconstruction. The other six patients had acceptable urinary incontinence by reconstruction of the bladder neck and urethra alone.

CONCLUSIONS

The primary injury is to the prostate and prostatic urethra. The bladder neck and subprostatic urethra are involved secondarily by extension. These injuries have a particular cause and a particular location with a predictable outcome. They need to be identified and treated promptly as they do not heal spontaneously and otherwise cause considerable morbidity. We also describe two particular types of bladder neck injury that we have not seen described before in adults.     

Initial management of low‐risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry

Study Type – Therapy (outcomes research)
Level of Evidence 2c

OBJECTIVE

To assess the patterns of care for low‐risk localized prostate cancer. Management of this condition is highly controversial, with a range of treatment options, but there are no published UK data.

METHODS

Data from the British Association of Urological Surgeons (BAUS) Cancer Registry were linked to the UK Association of Cancer registries postcode directory. The demographic and clinical characteristics, and the initial management of men diagnosed with low‐risk localized prostate cancer in the UK between 2000 and 2006 were analysed.

RESULTS

In all, 43 322 cases of localized prostate cancer were recorded in the BAUS Registry between 2000 and 2006, of which 8861 (20%) met the criteria for low‐risk disease. The proportion classified as low risk ranged from 16% in 2000 to 21% in 2006. The proportion of men with low‐risk disease opting for ‘watchful waiting’ increased from 0% to 39% over the same period. Treatment choice was associated with socio‐economic status. For example, radical prostatectomy was chosen by 34% of patients in the most affluent quintile, compared with 19% in the most deprived quintile (P= 0.01).

CONCLUSION

The management of low‐risk localized prostate cancer in the UK has changed markedly in recent years, and contrasts with that in the USA. The association observed between socio‐economic status and choice of treatment deserves further study.     

Treatment and outcome of traumatic biliary injuries in children

Background/Purpose

Traumatic biliary tract injuries in children are rare but may result in significant morbidity. The objective of this study was to review the occurrence of traumatic biliary tract injuries in children, management strategies, and outcome.

Methods

We conducted a retrospective review of patients with biliary tract injury using the trauma registry at our level 1 pediatric trauma center from 2002–2012.

Results

Twelve out of 13,582 trauma patients were identified, representing 0.09% of all trauma patients. All were secondary to blunt trauma. Mean age was 9.7 years [range 4–15], and mean Injury Severity Score was 31 ± 14, with overall survival of 92%. Biliary injuries included major ductal injury (6), minor ductal injury with biloma (4), gallbladder injury (2), and intrahepatic ductal injury (1). Major ductal injuries were managed by endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent (5) and Roux-en-Y hepaticojejunostomy (1). Associated gallbladder injury was managed by cholecystectomy. In addition, the associated biloma was managed with percutaneous drainage (7), laparoscopic drainage (2), or during laparotomy (3). Two patients with ductal injuries developed late strictures after initial management with ERCP and stent placement. One of the two patients ultimately required a left hepatectomy, and the other has been managed conservatively without evidence of cholangitis. Two patients required placement of additional drains and prolonged antibiotics for superinfection following biloma drainage.

Conclusion

Biliary tract injuries are rare in children, and many are amenable to adjunctive therapy, including ERCP and biliary stent placement with or without placement of a peritoneal drain. Patients with a discrete ductal injury are at higher risk for stricture and require close follow up. Hepaticojejunostomy remains the definitive repair for large extrahepatic biliary tract injuries or transections.     

Genitourinary trauma

Genitourinary (GU) organs are commonly injured in trauma patients. Although the kidney is the most commonly injured organ, other GU structures such as the bladder and urethra are also susceptible to injury. GU trauma is broadly divided into blunt and penetrative and based on the mechanism of injury. Prompt diagnosis and recognition of iatrogenic GU injury is also paramount. A delay in diagnosis and treatment can have significant consequences (e.g. abscess formation, fistulae and permanent renal impairment in the case of ureteric injury). Not all GU injuries require urgent surgery. Some can be managed with minimally invasive techniques (such as angiographic embolization), whereas others are managed entirely conservatively. The immediate management of these patients is geared towards haemodynamic stability. Haemodynamic shock that is resistant to the usual resuscitative measures often suggests ongoing bleeding and need for immediate intervention. The early management of most GU injuries with delayed presentation includes urinary diversion (through insertion of nephrostomy tube or suprapubic or urethral urinary catheter insertion) with delayed and definitive surgical reconstruction taking place at a later stage. Using the most up-to-date guidelines and published data we summarize the management of GU trauma by affected organ.     

Genitourinary trauma

Genitourinary (GU) organs are commonly injured in trauma patients. Although the kidney is the most commonly injured organ, other GU structures such as the bladder and urethra are also susceptible to injury. GU trauma is broadly divided into blunt and penetrative based on the mechanism of injury. Prompt diagnosis and recognition of iatrogenic GU injury are also paramount. A delay in diagnosis and treatment can have significant consequences – for example, abscess formation, fistulae and permanent renal impairment in the case of ureteric injury. Not all GU injuries require urgent surgery. Some can be managed with minimally invasive techniques (such as angiographic embolization) whilst others are managed entirely conservatively. The immediate management of these patients is geared towards haemodynamic stability. Haemodynamic shock that is resistant to the usual resuscitative measures often suggests ongoing bleeding and need for immediate intervention. The early management of most GU injuries with delayed presentation includes urinary diversion (through insertion of nephrostomy tube or suprapubic or urethral urinary catheter insertion) with delayed and definitive surgical reconstruction taking place at a later stage. Using the most up-to-date guidelines and published data we summarize the management of GU trauma by affected organ.     

Fecal continence following complex anorectal trauma in children

Background

Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries.

Methods

We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review.

Results

Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n = 9), rectum (n = 8), or destructive injury to both the anus and rectum (n = 4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1–14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy.

Conclusions

With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program.     

Contemporary management and prognosis of great vessels trauma

BackgroundGreat vessel trauma (GVT), which is defined as trauma to the aorta or vena cava, remains one of the most challenging injuries to treat and has a high mortality rate despite advances in modern medicine. Additionally, the optimal management of GVT is controversial. In this study, we review the incidence, management, and outcome of GVT, identify the current status and prognostic factors of GVT, and compare treatment outcomes.MethodsWe conducted a retrospective, single-center, cohort study of patients with GVT in a Level I trauma center from August 2008 to December 2013. We retrieved demographic data, physical and imaging findings, injury severity score (ISS), treatment choice, length of hospital stay, and mortality. We analyzed the risks of adverse outcomes and mortality.ResultsThe seventy-four patients in this cohort had a mean age of 41.6 (SD 17.7) years and a high mortality rate of 27%. The prognostic factors of survival with GVT included male gender, lower ISS, higher GCS, higher SBP and DBP and vena caval injuries. We also determined that vena caval injury is the main factor that can predict mortality.ConclusionIn conclusion, GVT is relatively rare but often lethal in clinical practice. Patient survival depends on injury severity and the shock status grade. Aggressive resuscitation and treatment play important roles in survival. The coordination of different levels of surgical expertise and the application of novel treatment methods are required to improve clinical outcomes for patients with vena caval injuries.     

Trauma in children: abdomen and thorax

The commonest cause of death in children in developed countries is trauma, accounting for over 350 deaths/year in the UK. In children, about 75% of trauma occurs on the roads and the majority of these involve blunt trauma with most children sustaining multiple injuries. It is more common in boys (about two- to threefold) and in the summer. The age distribution is bimodal with peaks affecting toddlers and teenagers. Mortality and morbidity have been reduced by preventative strategies, for example traffic calming systems, road safety programmes, seat belts, better car design and bicycle helmets. Once injured, swift management by skilled staff in a trauma network gives the best results and key to this are care in transport, and recognition and management of the injuries and finally rehabilitation. Important strategies for major trauma include what has become known as ‘damage limitation surgery’. In children, the absence of a plausible mechanism of injury should raise the suspicion of child abuse, and a plausible mechanism but an unusual situation might suggest neglect (e.g. a skate board injury in an 8-year-old at 23:00 hours).     

The British Association of Urological Surgeons: guidelines for training in laparoscopy

OBJECTIVE: To report the guidelines of the British Association of Urological Surgeons (BAUS), commissioned by the National Institute for Health and Clinical Excellence (NICE) in response to safety concerns about the rapid uptake of new, complex laparoscopic procedures. METHODS: A combination of expert opinion and review of published studies was used to produce a consensus document. RESULTS: Patient demand and excellent published reports have prompted many consultant urologists with little previous laparoscopic training to learn laparoscopic procedures. Laparoscopic urological surgery involves some of the most complex procedures in all of surgery and there has been a lack of formal training for consultants. The guidelines produced by BAUS are designed to help consultant urologists gain experience safely, by a combination of didactic learning and mentorship. We recommend that urologists work with a mentor and master ablative laparoscopic surgery before attempting more complex procedures such as prostatectomy, cystectomy, pyeloplasty and partial nephrectomy. These guidelines were approved by BAUS Council in October 2006. CONCLUSIONS: These guidelines are intended to be complementary to the NICE guidelines on specific procedures (available at http://www.nice.org.uk).     

Throwing out the "grade" book: management of isolated spleen and liver injury based on hemodynamic status

Purpose

Current organizational guidelines for the management of isolated spleen and liver injuries are based on injury grade. We propose that management based on hemodynamic status is safe in children and results in decreased length of stay (LOS) and resource use compared to current grade-based guidelines.

Methods

Patients with spleen or liver injuries for a 5-year period were identified using our institutional trauma registry. All patients were managed using a pathway based on hemodynamic status. Charts were reviewed for demographics, mechanism, hematrocrit values, transfusion requirement, imaging, injury grade, LOS, and outcome. Exclusion criteria included penetrating mechanism, associated injuries altering LOS or ambulation status, combined spleen/liver injury, initial operative management or death. Statistical comparison was performed using Student's t test; P < .05 is significant.

Results

One hundred one patients (50 spleen, 51 liver) meeting inclusion criteria were identified. Average actual LOS for all patients was 1.9 days vs 3.2 projected days based on American Pediatric Surgical Association guidelines (P < .0001). Actual vs projected LOS for grades III to V was 2.5 vs 4.3 days (P < .0001). All patients returned to full activity without complication.

Conclusions

Isolated blunt spleen and liver injuries, regardless of grade, can be safely managed using a pathway based on hemodynamic status, resulting in decreased LOS and resource use compared to current guidelines.     

Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study

OBJECTIVE

To report a series of children with lower urinary tract dysfunction (LUTD) whose urge syndrome was treated by electrical stimulation, and their voiding dysfunction by biofeedback; none of the children were using anticholinergic drugs during treatment.

PATIENTS AND METHODS

In all, 36 children who presented with symptoms of urinary urgency and/or daily incontinence completed the treatment and were prospectively evaluated. The mean (range) follow‐up was 13.8 (4–24) months, and their mean age 7 (3–14) years, 17 children were aged <5 years. The children were divided into two groups: group 1, with urge syndrome treated with superficial parasacral electrical stimulation, and group 2, with voiding dysfunction, treated with biofeedback.

RESULTS

In group 1, the mean (range) number of electrical stimulation sessions was 13.1 (4–20). Of the 19 children treated, 12 had a complete clinical improvement, six a significant improvement, and one a mild improvement. In group 2, the mean (range) number of biofeedback sessions was 6 (4–14). Of the 17 children treated, there was complete improvement of symptoms in 10, significant improvement in two and mild improvement in five. Six children who had no resolution of symptoms after biofeedback had salvage therapy with electrical stimulation, after which four had complete improvement of symptoms, and two a 90% and 40% improvement, respectively. Taking the two groups together, after treatment, four children developed isolated episodes of urinary tract infection. Of 21 children with nocturnal enuresis, bed‐wetting continued in 13 (62%) after treatment.

CONCLUSION

In this short‐term follow‐up, the nonpharmacological treatment of voiding dysfunction using biofeedback, and of urge syndrome by electrical stimulation, was effective for treating LUTD in children.