Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical Trial


We assessed efficacy of biofeedback therapy and home pelvic floor muscle exercises in children with dysfunctional voiding (DV) associated with mild to moderate hydronephrosis. This prospective study comprised fifty seven children (21 boys, 36 girls; mean age 8.9 ± 2.6) with DV and mild to moderate hydronephrosis. Children were randomly allocated into two treatment groups including control group who underwent standard urotherapy and case group who received biofeedback therapy in addition to standard urotherapy. A 99mTc diethylenetriamine pentaacetic acid (99mDTPA) scan, voiding cystoureterography, kidney and bladder ultrasounds, voiding diary and uroflowmetry with electromyography (EMG) were performed in all study participants at the baseline. Children with evidence of complete obstruction in DTPA scan and vesicoureteral reflux were excluded from enrollment. A complete voiding diary, kidney and bladder ultrasounds and uroflowmetry/EMG were also performed 6 months and 1 year after completion of the treatment. We noted a more significant decline in anteroposterior pelvic diameter in case group compared to control group (P < 0.05). The mean maximal urine flow rate prior to treatment was 16.5 ± 2.6 and 16.1 ± 3 ml/s in case and control groups, respectively. This finding increased significantly 1 year after the treatment in case group compared to controls (25 ± 7.2 ml/s vs. 18.4 ± 5.9 ml/s, respectively; P < 0.001). Improvement of various parameters in voiding diary was also more significant in the case group. Biofeedback therapy can effectively resolve non-refluxing and non-obstructive hydronephrosis in children with DV.

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Fig. 1
Fig. 2



Anteroposterior pelvic diameter


Biofeedback therapy


Dysfunctional voiding


International Children’s Continence Society




Post void residual


Pelvic floor muscle


Standard urotherapy


Urinary tract infection


Vesicoureteral reflux


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We are highly grateful to Mrs. Safieh Lotfi for her precise final linguistic revision of the manuscript.

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Correspondence to Abdol-Mohammad Kajbafzadeh.

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The authors declare that they have no conflict of interest.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the local ethics committee of Tehran University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ladi-Seyedian, S., Sharifi-Rad, L., Amini, E. et al. Resolution of Hydronephrosis in Children with Dysfunctional Voiding After Biofeedback Therapy: A Randomized Clinical Trial. Appl Psychophysiol Biofeedback (2020).

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  • Dysfunctional voiding
  • Hydronephrosis
  • Urotherapy
  • Children
  • Biofeedback