Urotherapy for lower Urinary Tract Dysfunction in Children following Sexual Abuse

Abstract Purpose Management of lower urinary tract dysfunctions (LUTD) following sexual abuse in pediatric patients is challenging. Material and Methods 2 girls with LUTD following repeated sexual abuse were evaluated. The first one is a black race ethiopian girl kidnapped in her village at 8 years old and then repeated beaten and abused; the second one is an white caucasian girl , raped by her boy friend at the age of 12 years old and then forced to prostitution for 2 years. The 2 girls were saved at 13 and 14 years respectively and immediately started psycotherapy. Urinary retention was the predominant symptom in both, presenting constipation and urinary tract infection too. Results Patients were evaluated with bladder diary, renal ultrasound and no invasive urodynamic study before to start a standard urotherapy regimen, discussed by a team including urologists, urotherapists, psychologist, etc. Patients started with no-invasive Biofeedback (BFB) for 3 months with partial benefits, following a multidisciplinary re-evaluation. The first one performed other 8 BFB session plus no invasive pelvic floor physiotherapy, in the second one we decided for one cycle (12 sessions) of tibial-nerve-neuromodulation (PTNS). RESULTS showed costant decrease of post-void residual and increased frequency and voided volume. LUTD completely solved after 18 and 24 months, and at 2 and 5 years follow-up respectively patients are still free from urinary symptoms. Conclusions LUTD following sexual abuse need a multidisciplinary treatment including psycological support and no-invasive urotherapy. PTNS and BFB confirmed their efficacy and acceptance in sexually abused children too.