***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 PURPOSE We studied the effect of transcutaneous electrical nerve stimulation in children with overactive bladder and treatment refractory daytime urinary incontinence . MATERIAL S AND METHODS We recruited 27 children 5 to 14 years old with daytime urge incontinence refractory to timer assisted st and ard urotherapy and anticholinergics who had normal urinalysis , and unremarkable urinary tract ultrasound and physical examination . Study exclusion criteria were bladder underactivity , lower urinary tract obstruction , ongoing defecation disorders , lower urinary tract surgery and previous transcutaneous electrical nerve stimulation . After a 2-week run-in of st and ard urotherapy the children underwent natural fill ambulatory urodynamics to confirm detrusor overactivity . Subsequently they were r and omly allocated to 4 weeks of 2 hours of daily active or placebo S2-S3 transcutaneous electrical nerve stimulation . The severity of incontinence and urgency , and 48-hour bladder diaries were recorded before r and omization and during intervention week 4 . Children withdrew from anticholinergics throughout the study period . RESULTS Two children were excluded from r and omization due to urodynamic signs of lower urinary tract obstruction . After 4 weeks of intervention 8 children ( 61 % ) in the active group showed a significant decrease in incontinence severity but this occurred in only 2 ( 17 % ) in the sham treated group ( p < 0.05 ) . The active group had a significantly greater decrease in daily incontinence episodes compared to the sham treated group ( p < 0.01 ) . Transcutaneous electrical nerve stimulation did not alter maximal and average voided volumes . CONCLUSIONS Sacral transcutaneous electrical nerve stimulation seems superior to placebo for refractory daytime incontinence in children with overactive bladder . This effect does not seem to be a consequence of improved bladder reservoir function 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 We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children . We design ed a prospect i ve r and omized trial with sham control for this evaluation . MATERIAL S AND METHODS We prospect ively r and omized 25 girls and 12 boys with an average age of 7.6 years ( range 4 to 12 ) into the test ( active treatment ) or sham ( superficial scapular electrical stimulation ) group . A total of 20 sessions , 20 minutes each ( 10 Hz ) were performed 3 times weekly . The criteria used to evaluate the rate of success were 1 ) self-reported cure , or significant , mild or no improvement ; 2 ) visual analogue scale ( level of success 0 to 10 ) ; 3 ) percent improvement ; 4 ) modified Toronto score ; and 5 ) maximum voided volume , average voided volume and number of voids daily based on bladder diary entries . After completion of the 20 sessions controls who were not cured underwent active treatment . RESULTS A total of 21 patients in the test group and 16 in the sham group underwent treatment . Among the active treatment group 61.9 % of parents reported cure . In the sham group no parent reported cure ( p < 0.001 ) . Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group , while 1 parent in the sham group indicated a score of 9 ( p = 0.002 ) . Additionally 100 % improvement was reported by 12 parents in the test group and no parent in the sham group . Toronto score improved significantly in the test group ( p < 0.001 ) and sham group ( p = 0.008 ) . However , the score was reduced more significantly in the test group compared to the sham group ( p = 0.011 ) . In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased . After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured . CONCLUSIONS This is the first known r and omized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder BACKGROUND Dysfunctional voiding ( DV ) in neurologically normal children is characterized by involuntary intermittent contractions of either the striated muscle in external urethral sphincter , or the pelvic floor during voiding . Urinary incontinence , pelvic holding maneuvers , voiding difficulties , urinary tract infections ( UTIs ) , constipation and vesicoureteral reflux are highly associated with DV . AIM To investigate the role of abdominal and pelvic floor muscle ( PFM ) retraining in children with DV . DESIGN Prospect i ve clinical controlled study SETTING Outpatient clinical facility POPULATION Forty-three children , 5 - 13 years of age , with dysfunctional voiding METHODS In addition to st and ard urotherapy ( education , timed voiding , adequate fluid intake , voiding posture and pattern , constipation management and hygiene issues ) , children were assigned abdominal and PFM retraining . Diaphragmatic breathing exercises were done in lying and sitting positions , for the purpose of achieving abdominal muscle relaxation . PFM retraining consisted of low-level three-second contractions followed by thirty-second relaxation periods . Selected children received pharmacotherapy ( anticholinergics or desmopressin ) . Recurrent symptomatic UTIs were treated with antibiotic prophylaxis . Uroflowmetry with PFM electromyography and ultrasound residual urine volumes were obtained before and at the end of the 12-month treatment period . Clinical manifestations and uroflowmetry parameters were analysed before and after the therapy . RESULTS After one year of therapy , urinary incontinence was cured in 20 out of 24 patients ( 83 % ) , nocturnal enuresis in 12 out of 19 children ( 63 % ) , while 13 out of 19 children ( 68 % ) were UTI free . All 15 patients recovered from constipation . Post-treatment uroflowmetry parameters showed significant improvements and a bell-shaped curve was observed in 36 out of 43 children . CONCLUSION In combination with st and ard urotherapy , abdominal and pelvic floor muscle retraining is beneficial for curing urinary incontinence , nocturnal enuresis and UTIs in children with DV , as well as for normalizing urinary function . Further trials are needed to define the most effective treatment program which would result in the best treatment outcome . CLINICAL REHABILITATION IMPACT To improve clinical and objective treatment outcome in dysfunctional voiders . Diaphragmatic breathing and pelvic floor muscle exercises are simple and easy to learn and could be assigned to children aged 5 or older . As they do not require special equipment , they can be performed at all health care levels OBJECTIVE Pediatric dysfunctional voiding ( DV ) presents physical and emotional challenges as well as risk of progression to renal disease . Manual physical therapy and osteopathic treatment have been successfully used to treat DV in adult women ; a pediatric trial of manual physical therapy based on an osteopathic approach ( MPT-OA ) has not been reported . The aim of this study was to determine whether MPT-OA added to st and ard treatment ( ST ) improves DV more effectively than ST alone . METHODS Twenty-one children ( aged 4 - 11 years ) with DV were r and omly assigned to receive MPT-OA plus st and ard treatment ( treatment group ) or st and ard treatment alone ( control group ) . Pre-treatment and post-treatment evaluations of DV symptoms , MPT-OA evaluations and inter-rater reliability of DV symptom resolution were completed . RESULTS The treatment group exhibited greater improvement in DV symptoms than did the control group ( Z=-2.63 , p=0.008 , Mann-Whitney U-test ) . Improved or resolution of vesicoureteral reflux and elimination of post-void urine residuals were more prominent in the treatment group . CONCLUSIONS Results suggest that MPT-OA treatment can improve short-term outcomes in children with DV , beyond improvements observed with st and ard treatments , and is well liked by children and parents . Based on these results , a multi-center r and omized clinical trial of MPT-OA in children with vesicoureteral reflux and /or post-void urinary retention is warranted PURPOSE The aim of this study is to evaluate and compare the effectiveness of animated vs. non-animated biofeedback therapy in the treatment of dysfunctional voiding ( DV ) in the pediatric age group . METHODS In this study , children with DV were r and omly assigned for animated and non-animated biofeedback therapy .  Age , voiding dysfunction symptom scores ( VDSS ) , urinary ultrasound and uroflowmetry parameters such as electromyography ( EMG ) activity , voided volumes , post voiding residual urine volume ( PVR ) and maximum flow rate ( Qmax ) were evaluated . At the end of treatment , clinical success was regarded as the cessation of EMG activity during voiding , resolution of symptoms ( reduction in VDSS , frequency , intermittency , urgency and incontinence ) , and improvements in uroflowmetry parameters . RESULTS A total of 40 children were included in the study . There were 20 children in the non-animated group ( 16 girls , 4 boys ; mean age : 10.5±3.2years ) and 20 children in the animated group ( 15 girls , 5 boys ; mean age : 9.5±3.63years ) . Patients received a mean of 5.2±1.9 sessions in both groups . Cessation of pelvic muscle activity on EMG was 75 % in the non-animated group and 90 % in the animated group ( p=0.407 ) . Reduction in VDSS was clinical ly significant in both groups ( p=0.001 for both ) . There was no significant difference between the clinical success rates of the nonanimated and animated groups ( 80 % vs. 70 % respectively , 
    Output:
    
The review found little reliable evidence that can help affected children , their carers and the clinicians working with them to make evidence -based treatment decisions .