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  3. Vol. 22 No. 05 (2025): September-October2025
  4. ORIGINAL PAPER (PEDIATRIC UROLOGY)

Vol. 22 No. 05 (2025)

November 2025

Evaluation of the Effectiveness of Dynamic Neuromuscular Stabilization Training in Children Diagnosed with Lower Urinary Tract Dysfunction and Comparison with EMG Biofeedback Treatment: A Pilot Study

  • Emine Nacar
  • Sinem Suner Keklik
  • Ahmet Taner Elmas

Urology Journal, Vol. 22 No. 05 (2025), 11 November 2025 , Page 244-249
https://doi.org/10.22037/uj.v22i.8348 Published: 2025-11-10

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Abstract

Purpose: This study was designed to evaluate the effectiveness of dynamic neuromuscular stabilization (DNS) training in children with non neurogenic lower urinary tract dysfunction (LUTD) and compare it with biofeedback (BF) treatment.
Materials and Methods: A total of 15 participants aged 6–15 years with non neurogenic LUTD were divided into three groups: Group I, DNS exercise training; Group II, BF training; and Group III, DNS plus BF training. Dysfunctional Voiding and Incontinence Scoring System (DVISS) scores, uroflowmetry parameters, uroflow curve, post void residual (PVR) values, and deep trunk muscle strength were evaluated at baseline and at 4, 8, and 12 weeks after treatment.
Results: Total DVISS scores significantly decreased after 12 weeks in Groups I and III, while Group II showed
significant decreases at 4 and 8 weeks (P < .05). Improvements in deep trunk muscle strength at 4 and 8 weeks were significantly greater in Groups I and III than in Group II (P < .05). In Group I, average flow rate increased at 4 weeks and flow time decreased at 12 weeks (P < .05). PVR decreased significantly at 12 weeks in Group I and at 8 weeks in Group III (P < .05).
Conclusion: DNS and BF training are effective in improving symptoms in patients with non neurogenic LUTD; however, groups receiving DNS exercises were superior for several parameters.

Keywords:
  • Children
  • lower urinary tract dysfunction
  • biofeedback
  • pelvic floor rehabilitation
  • dynamic neuromuscular stabilization
  • 8348/pdf

How to Cite

Nacar, E., Suner Keklik, S., & Elmas, A. T. (2025). Evaluation of the Effectiveness of Dynamic Neuromuscular Stabilization Training in Children Diagnosed with Lower Urinary Tract Dysfunction and Comparison with EMG Biofeedback Treatment: A Pilot Study. Urology Journal, 22(05), 244–249. https://doi.org/10.22037/uj.v22i.8348
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References

Sharifi-Rad L, Ladi-Seyedian S-S, Kajbafzadeh A-M. Interferential electrical stimulation efficacy in the management of lower urinary tract dysfunction in children: A review of the literature. Urol J. 2021;18:469-76.

Vaz GT, Vasconcelos MM, Oliveira EA, Ferreira AL, Magalhães PG, Silva FM, et al. Prevalence of lower urinary tract symptoms in school-age children. Pediatr Nephrol. 2012;27:597-603.

Fuentes M, Magalhães J, Barroso Jr U. Diagnosis and management of bladder dysfunction in neurologically normal children. Front Pediatr. 2019;7:298.

Peco-Antić A, Miloševski-Lomić G. Development of the lower urinary tract and its functional disorders. Srp Arh Celok Lek. 2015;143(3-4):219-25.

Gong S, Khosla L, Gong F, Kasarla N, Everaert K, Weiss J, et al. Transition from childhood nocturnal enuresis to adult nocturia: a systematic review and meta-analysis. Res Rep Urol. 2021:823-32.

Selvi I, Basar H, Baydilli N, Kizilay E, Demirci D. Which children are at risk of developing overactive bladder in early adulthood even if lower urinary tract symptoms improve during childhood? Int J Urol. 2022;29(2):136-42.

Kakizaki H, Kita M, Watanabe M, Wada N. Pathophysiological and therapeutic considerations for non‐neurogenic lower urinary tract dysfunction in children. Low Urin Tract Symptoms. 2016;8(2):75-85.

Morgan KE, Leroy SV, Corbett ST, Shepard JA. Complementary and integrative management of pediatric lower urinary tract dysfunction implemented within an interprofessional clinic. Children (Basel). 2019;6(8):88.

Buckley BS, Sanders CD, Kwong JS, Kilpatrick KA, Anderson CA. Conservative treatment for functional daytime urinary incontinence in children. Cochrane Database Syst Rev. 2016;2016(9).

de Jong TP, Klijn AJ, Vijverberg MA, de Kort LM, van Empelen R, Schoenmakers MA. Effect of biofeedback training on paradoxical pelvic floor movement in children with dysfunctional voiding. Urology. 2007;70(4):790-3.

Paepe HD, Renson C, Hoebeke P, Raes A, Laecke EV, Walle JV. The role of pelvic-floor therapy in the treatment of lower urinary tract dysfunctions in children. Scand J Urol Nephrol. 2002;36(4):260-7.

Ladi-Seyedian S-S, Sharifi-Rad L, Nabavizadeh B, Kajbafzadeh A-M. Traditional biofeedback vs. pelvic floor physical therapy—is one clearly superior? Curr Urol Rep. 2019;20:1-9.

Ladi-Seyedian S-S, Sharifi-Rad L, Kajbafzadeh A-M. Pelvic floor electrical stimulation and muscles training: a combined rehabilitative approach for management of non-neuropathic urinary incontinence in children. J Pediatr Surg. 2019;54(4):825-30.

Messelink B, Benson T, Berghmans B, Bø K, Corcos J, Fowler C, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374-80.

Neumann P, Gill V. Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J. 2002;13:125-32.

Zivkovic V, Lazovic M, Vlajkovic M, Slavkovic A, Dimitrijevic L, Stankovic I, et al. Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding. Eur J Phys Rehabil Med. 2012;48(3):413-21.

Ladi Seyedian SS, Sharifi-Rad L, Ebadi M, Kajbafzadeh A-M. Combined functional pelvic floor muscle exercises with Swiss ball and urotherapy for management of dysfunctional voiding in children: a randomized clinical trial. Eur J Pediatr. 2014;173:1347-53.

Park C, Yoon S, Yoon H, Kim K, Cha Y, Park I. Effects of core stabilization exercise on muscle activity during horizontal shoulder adduction with loads in healthy adults: a randomized controlled study. J Mech Med Biol. 2021;21(09):2140049.

Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther. 2013;8(1):62.

Hutson M, Ward A. Oxford textbook of musculoskeletal medicine: Oxford University Press; 2015.

Kolář P, Šulc J, Kynčl M, Šanda J, Čakrt O, Andel R, et al. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):352-62.

Milić Z. The effects of neuromuscular stabilization on increasing the functionality and mobility of the locomotor system. Sports Science and Health. 2020;19(1):54-9.

Kim D-H, An D-H, Yoo W-G. Effects of 4 weeks of dynamic neuromuscular stabilization training on balance and gait performance in an adolescent with spastic hemiparetic cerebral palsy. J Phys Ther Sci. 2017;29(10):1881-2.

Akbal C, Genc Y, Burgu B, Ozden E, Tekgul S. Dysfunctional voiding and incontinence scoring system: quantitative evaluation of incontinence symptoms in pediatric population. The J Urol. 2005;173(3):969-73.

Bauer SB, Nijman RJ, Drzewiecki BA, Sillen U, Hoebeke P. International Children's Continence Society standardization report on urodynamic studies of the lower urinary tract in children. Neurourol Urodyn. 2015;34(7):640-7.

Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourol Urodyn. 2016;35(4):471-81.

Johnson EK, Bauer SB. Neurogenic Voiding Dysfunction and Functional Voiding Disorders: Evaluation and Nonsurgical Management. The Kelalis--King--Belman Textbook of Clinical Pediatric Urology: CRC Press; 2018. p. 820-52.

Mahdieh L, Zolaktaf V, Karimi MT. Effects of dynamic neuromuscular stabilization (DNS) training on functional movements. Hum Mov Sci. 2020;70:102568.

Sener NC, Altunkol A, Unal U, Ercil H, Bas O, Gumus K, et al. Can a four-session biofeedback regimen be used effectively for treating children with dysfunctional voiding? Int Urol Nephrol. 2015;47:5-9.

Erasmie U, Lidefelt K-J. Accuracy of ultrasonic assessment of residual urine in children. Pediatr Radiol. 1989;19:388-90.

de Paula Lima PO, de Oliveira RR, Costa LOP, Laurentino GEC. Measurement properties of the pressure biofeedback unit in the evaluation of transversus abdominis muscle activity: a systematic review. Physiotherapy. 2011;97(2):100-6.

Falla D, O’Leary S, Farina D, Jull G. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. The Clin J Pain. 2012;28(7):628-34.

Barton B, Peat J. Medical statistics: A guide to SPSS, data analysis and critical appraisal: John Wiley & Sons; 2014.

Chang SJ, Van Laecke E, Bauer SB, von Gontard A, Bagli D, Bower WF, et al. Treatment of daytime urinary incontinence: a standardization document from the International Children's Continence Society. Neurourol Urodyn. 2017;36(1):43-50.

Kopru B, Ergin G, Ebiloglu T, Kibar Y. Does biofeedback therapy improve quality of life in children with lower urinary tract dysfunction: parents' perspective. J Pediatr Uro. 2020;16(1):38. e1-. e7.

Fazeli MS, Lin Y, Nikoo N, Jaggumantri S, Collet J-P, Afshar K. Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2015;193(1):274-80.

Berg-Poppe P, Christensen M, Koskovich N, Stephenson C. Pelvic Floor Muscle Resting Tone in Children With Dysfunctional Voiding Symptomology Following Simple Gross Motor Exercises. Pediatr Phys Ther. 2022;34(1):28-35.

McKenna PH, Herndon CA, Connery S, Ferrer FA. Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games.

J Urol. 1999;162(3 Part 2):1056-62.

Vesna Z, Milica L, Marina V, Andjelka S, Lidija D. Correlation between uroflowmetry parameters and treatment outcome in children with dysfunctional voiding. J Pediatr Urol. 2010;6(4):396-402.

Bower WF, Yew S, Sit K, Yeung C. Half-day urotherapy improves voiding parameters in children with dysfunctional emptying. Eur Urol. 2006;49(3):570-4.

Son MS, Jung DH, You JSH, Yi CH, Jeon HS, Cha YJ. Effects of dynamic neuromuscular stabilization on diaphragm movement, postural control, balance and gait performance in cerebral palsy. NeuroRehabilitation. 2017;41(4):739-46.

Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Man Ther. 2004;9(1):3-12.

Ghaderi F, Mohammadi K, Sasan RA, Kheslat SN, Oskouei AE. Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and urinary incontinence in women. Urology. 2016;93:50-4.

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