The following is a summary of “Does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?,” published in the March 2024 issue of Pediatrics by Zahir et al.

This retrospective cohort study aimed to investigate the potential influence of sacral ratios (SRs) on the response to biofeedback (BF) therapy in pediatric patients with lower urinary tract dysfunction (LUTD).

Conducted at the tertiary medical center from 2016 to 2018, this study analyzed the medical records of pediatric patients with LUTD who were referred for BF therapy due to abnormal uroflowmetry patterns and simultaneous electromyography (EMG) activity increase. Ten weekly animated BF sessions were administered to each patient. Pre- and post-treatment assessments included a complete urological evaluation, uroflowmetry with simultaneous EMG, and post-void residual measurement. SRs were calculated from plain anteroposterior lumbosacral radiographs, and patients were categorized into normal SR (≥0.74) and low SR (<0.74) groups for outcome comparison.

Of the 86 patients included, 48 (55.8%) had a normal SR (≥0.74), while 38 (44.2%) had a low SR (<0.74). BF therapy significantly improved all patients’ urinary flow rates, urine volume, daytime urinary incontinence, enuresis, urinary urgency, and constipation (all P < 0.001). However, after treatment, the normal SR group exhibited significantly higher maximum urinary flow rate (mean difference [95%CI]: 7.7 [5.4, 10.0], P < 0.001), urine volume (mean difference [95%CI]: 49.9 [19.5, 80.4], P = 0.002), and lower diurnal urinary incontinence (4.2% vs. 21.1%, P = 0.020), enuresis (4.2% vs. 18.4%, P = 0.040), and constipation (2.1% vs. 23.7%, P = 0.004) compared to the low SR group.

SR indicates bony pelvis growth and lumbosacral neurodevelopment, with larger SR values linked to improved sphincter function in children with urological and anorectal malformations. The findings suggest that while BF therapy effectively treats LUTD in all patients, those with enhanced sacral development may exhibit superior clinical responses, particularly in symptom improvement.

Although BF therapy is efficacious for children with LUTD regardless of sacral development, those with higher SR values may experience better clinical outcomes, underscoring the potential utility of SR assessment in treatment planning.

Source: sciencedirect.com/science/article/abs/pii/S1477513124001797