***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We report the clinical results of two types of urotherapy programs in children with dysfunctional voiding ( DV ) . Sixty children with a median age of 8 ( range , 5–14 ) diagnosed with DV were r and omly allocated to one of two groups , each made up of 30 patients . Patients in group A underwent behavioral urotherapy ( hydration , scheduled voiding , toilet training , and high-fiber diet ) combined with pelvic floor muscle ( PFM ) exercises , whereas group B only received behavioral urotherapy . All parents completed a voiding and bowel habit diary chart . Uroflowmetry with pelvic floor surface electromyography ( EMG ) and bladder ultrasound were performed on all patients at the beginning and the end of the 1-year study . Abnormal voiding pattern normalized to a bell shape in 21/30 of patients in group A and 8/30 of patients in group B ( P < 0.000 ) . EMG activity during voiding disappeared significantly in 23/30 patients in group A compared to 15/30 patients in group B ( P < 0.02 ) . Episodes of urgency resolved in 12/14 of patients in group A and 3/11 of patients in group B ( P < 0.01 ) . Daytime wetting improved in 15/17 and 4/11 of patients in groups A and B , respectively . In addition , reduction in post-void residue ( PVR ) was significant in group A ( P < 0.003 ) . Conclusion : Functional PFM exercises with Swiss ball combined with behavioral urotherapy proved as a safe and effective therapeutic modality , reducing the frequency of urinary incontinence , PVR , and the severity of constipation in children with DV INTRODUCTION Although the short-term effects of urotherapy as a treatment strategy for lower urinary tract ( LUT ) conditions have been well documented , the long-term effects remain largely unknown . A better insight into the long-term effects of urotherapy could improve the clinical guidelines for children with incontinence . OBJECTIVE This study aim ed to investigate the long-term effects ( i.e. , from 6 months to 2 years ) from a clinical voiding reeducation program among children with LUT conditions . STUDY DESIGN This study was a prospect i ve continuation of the follow-up study of Hoebeke et al. ( 2011 ) . Thirty-eight children ( mean age 9 years ) with LUT conditions completed an extensive clinical voiding reeducation program ( VS ) . Data on medication , voiding , drinking , pelvic floor tone , uroflowmetry , and incontinence were recorded 2 years after the VS . These data were compared with the outcomes at 6 months follow-up and at intake before voiding school . RESULTS Six months after voiding school , 22 children continued having daytime incontinence ( ID ) and /or enuresis ( EN ) . Six of them became dry at 2 years . Conversely , 16 children were dry at 6 months , of which eight relapsed at 2 years . Whereas all parameters significantly improved 6 months after VS , further improvements from 6 months to 2 years could only be noticed for the proportion of children suffering from overactive bladder ( 92 % at intake , 55 % at 6-month follow-up and 18 % at 2-year follow-up ) ( Figure ) . Fluid intake and pelvic floor tone improved after 6 months , but showed a significant relapse after 2 years ( P = 0.013 , P = 0.031 , respectively ) . DISCUSSION Hoebeke et al. ( 2011 ) concluded that results continued to improve after VS . No further improvements could be noticed 2 years after VS , although individual shifts were present . The results of the present study underline the value of long-term follow-up to detect those needing ongoing treatment to prevent relapse . Fluid intake and pelvic floor tone deteriorated from 6 months to 2 years . It could be hypothesized that inadequate fluid intake , possibly leading to decreased voided volumes , may be seen as an indicator for upcoming incontinence relapse . It could be stated that adequate fluid intake and pelvic floor tone may play a role in remaining continent for the long term . Study limitations should be considered . The study population was heterogeneous and rather small . Together with other missing values , this could have influenced the results . CONCLUSION Close individual , long-term follow-up after clinical voiding reeducation in children is recommended in order to timely detect and prevent potential relapse OBJECTIVE To evaluate the effects of interferential current ( IC ) stimulation and diaphragmatic breathing exercises ( DBEs ) in children with bladder and bowel dysfunction . PATIENTS AND METHODS Seventy-nine children with dysfunctional voiding and chronic constipation who were failures of primary care interventions were included in the prospect i ve clinical study . All the children were checked for their medical history regarding lower urinary tract symptoms and bowel habits . Physical examination , including abdominal and anorectal digital examination , was performed . Children kept a bladder and bowel diary , and underwent urinalyses and urine culture , ultrasound examination of bladder and kidneys , and uroflowmetry with pelvic floor electromyography . Eligible children were divided into 3 groups ( A , B , and C ) . All groups were assigned education and behavioral modifications . Additionally , group A underwent DBEs and IC stimulation , whereas group B received only DBEs . The treatment was conducted for 2 weeks in the clinic in all 3 groups , . The behavioral modifications and DBEs were continued at home for 1 month . Clinical manifestations , uroflowmetry parameters , and postvoided residual urine were analyzed before and after 6 weeks of therapy . RESULTS After the treatment , significant improvement in defecation frequency and fecal incontinence was noticed only in group A ( P < .001 and P < .05 , respectively ) . These children demonstrated significant improvement in lower urinary tract symptoms and postvoided residual urine ( P < .001 and P < .05 , respectively ) . Bell-shaped uroflowmetry curve was observed in 73.3 % of group A patients ( P < .001 ) . CONCLUSION IC stimulation and DBEs are beneficial in chronically constipated dysfunctional voiders . Further trials are needed to define the long-term effects of this program PURPOSE Animated biofeedback is an established treatment for pediatric dysfunctional voiding .  Bowel dysfunction is closely associated with dysfunctional voiding . We evaluated the efficacy of animated biofeedback urotherapy in bowel and voiding dysfunction in children with dysfunctional elimination syndrome . MATERIAL S AND METHODS A total of 80 children with dysfunctional elimination syndrome were r and omly assigned to undergo animated biofeedback ( group A , 40 patients ) or conservative therapy ( group B , 40 patients ) . Group A underwent animated biofeedback along with pelvic floor muscle exercises and behavioral modification ( hydration , high fiber diet , scheduled voiding ) . Group B underwent behavioral modification only .  Dysfunctional voiding symptom score , constipation and fecal soiling episodes per week ( according to Paris Consensus on Childhood Constipation Terminology criteria ) , and uroflowmetry parameters were evaluated before and 6 and 12 months after treatment in both groups . RESULTS Subjective and objective voiding problems were significantly improved . Vesicoureteral reflux resolved in 7 of 9 children ( 78 % ) and urinary tract infection did not recur in 10 of 14 children ( 71 % ) within 1 year . Bladder capacity and voided volume did not significantly improve . Post-void residual and voiding time decreased considerably , while maximum and average urine flow increased significantly . All children with fecal soiling and 17 of 25 with constipation ( 68 % ) in group A were symptom-free within 1 year after treatment . Animated biofeedback therapy was more efficient than nonbiofeedback management regarding objective and subjective voiding problems and bowel dysfunction ( p < 0.05 ) . CONCLUSIONS Animated biofeedback effectively treats bowel and voiding dysfunction in children with dysfunctional voiding . Pelvic floor muscle exercises coordinate breathing and pelvic floor muscle contractions , and are beneficial in improving bowel dysfunction BACKGROUND The aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation ( TENS ) treatment improves the results of st and ard urotherapy in children with overactive bladder ( OAB ) symptoms . MATERIAL AND METHODS Sixty-two children with symptoms of OAB and incontinence were included . The children were r and omized either to st and ard urotherapy treatment alone or a combination of st and ard urotherapy and TENS . The effect variables were taken from a voiding-drinking diary : number of voiding , number of incontinence episodes , and maximum voided volume . RESULTS Both treatment groups had good treatment results , with no significant difference between the groups . In the st and ard treatment group 13/28 ( 46 % ) were completely dry and 11/28 ( 40 % ) had a decrease in incontinence episodes , compared to 16/24 ( 67 % ) and 3/24 ( 13 % ) , respectively , in the st and ard+TENS group ( p=0.303 ) . The number of voiding decreased in two-thirds of the patients in both groups . However , maximal voided volume only increased in the st and ard treatment group . Subjectively 72 % and 80 % considered themselves significantly improved or free of symptoms . Previous treatment was registered in 15/55 ( 27 % ) . All efficacy variables decreased in those with previous treatment , but with no difference between the st and ard and st and ard+TENS treatment groups . The only difference noted was when comparing the children without previous treatment in the groups : a significantly higher proportion were completely dry in the TENS group ( 12/18 [ 71 % ] versus 10/22 [ 48 % ] , p=0.05 ) . CONCLUSION Our results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy+TENS , whereas a tendency to difference was found in children without previous treatment . Thus with good urotherapy support , TENS only seems to have marginal additional effects on OAB symptoms INTRODUCTION Overactive bladder ( OAB ) is the most prevalent voiding disorder in childhood , and its main manifestation is urinary urgency . In general , urotherapy and anticholinergics are the first choices of treatment . Parasacral Transcutaneous Electrical Neural Stimulation ( PTENS ) was introduced as an alternative for the treatment of detrusor overactivity in children , but treatment protocol s described to date require several sessions per week or long-lasting sessions , making it difficult for the child to adhere to the treatment . Thus , this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children . STUDY DESIGN This prospect i ve , r and omized controlled trial included 16 children with OAB . Children were divided into two groups : CG ( urotherapy and electrical stimulation placebo ) and EG ( urotherapy and PTENS ) . For both groups , therapy was delivered in 20 weekly sessions , of duration 20 min each . Placebo electrical stimulation was done in the scapular area . The children were evaluated prior to treatment ( T1 ) , at the end of the 20 sessions ( T2 ) , and 60 days after the completion of treatment ( T3 ) , with a 3-day voiding diary , visual analogue scale ( VAS ) , Rome III diagnostic criteria , and the Bristol Scale . RESULTS The groups were similar in age , gender , and ethnicity . In the initial assessment , all children , in both groups , had urgency and incontinence , 50 % in each group had constipation , and enuresis was present in seven children ( 87.5 % ) in the EG and six ( 75 % ) in the CG . No differences were found between the groups regarding the volumetric measurements made in the voiding diary , urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale . Sixty days after treatment , a significant improvement was found in the EG group ( p = 0.03 ) regarding urgency ( Table ) , as well as an increase in dry nights in those presenting with enuresis ( p = 0.03 ) . No difference was noted regarding urinary incontinence ( Table ) . At the end of 20 sessions and after 60 days of treatment , those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS ( p = 0.05 and 0.04 , respectively ) . CONCLUSIONS Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis , and in the perception of those responsible for the children . Further studies with larger population s are needed to corroborate these results Purpose Our aim was to evaluate the efficacy of our treatment program for children with lower urinary tract conditions , developed at the Department of Pediatric Nephrology of the University Children ’s Hospital in Ljubljana . Methods Sixty-four patients with lower urinary tract conditions were r and omly allocated to two groups . Group A received treatment immediately , whereas patients of group B received no treatment for a period of 3 months — the amount of time it takes to complete our program . No child in group B experienced spontaneous regression of their symptoms in the 3-month delay period , while the patients of group A were already being treated and were achieving results . Thus , all the patients of group B then entered the program in exactly the same way as patients of group A. Results The final success rate in both groups did not differ significantly ( p = 0.706–1.000 ) and ranged from 86.2 % for group A and 86.7 to 90 % for group B. Long-term 
    Output:
    
The identified urotherapy components were : educational guidance , water intake , caffeine reduction , adequate voiding position , pelvic floor training , programmed urination , and constipation control/management .
This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement  with st and ard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction .