Hypopressive physiotherapy for refractory non-neurogenic underactive bladder in children: a retrospective case series.

BACKGROUND: Pediatric non-neurogenic underactive bladder (UAB) is characterized by reduced detrusor contractility, elevated post-void residual (PVR), and recurrent urinary tract infections (UTIs). Standard urotherapy and pelvic floor rehabilitation constitute first-line management, whereas clean intermittent catheterization (CIC) is frequently required in refractory cases. Hypopressive physiotherapy has shown benefit in adult pelvic floor dysfunction but has not been systematically evaluated in pediatric UAB. OBJECTIVE: To evaluate the clinical effectiveness of a structured hypopressive physiotherapy program as a specific urotherapy intervention in children with refractory non-neurogenic UAB. METHODS: A retrospective case series including six children with refractory non-neurogenic underactive bladder and baseline post-void residual volume >50 mL despite previous conservative treatment. All underwent a structured hypopressive physiotherapy program. Post-void residual volume, urinary tract infections, clean intermittent catheterization requirement, and uroflowmetry findings were evaluated at baseline, 6 months, and 12 months. Paired comparisons were performed using the Wilcoxon signed-rank test. RESULTS: Six children were included, including two with bladder dysfunction secondary to previously treated congenital lower urinary tract obstruction (posterior urethral valves and ureterocele, respectively). Mean baseline PVR was 123.3 ± 20.5 mL. At 6 months, mean PVR decreased to 29.2 ± 16.9 mL (p = 0.031). At 12 months, mean PVR was 12.5 ± 9.9 mL (p = 0.028). All patients achieved PVR ≤20 mL during follow-up. Recurrent UTIs resolved in all cases. One patient discontinued CIC. Uroflowmetry curves partially normalized in three patients, while two maintained plateau morphology despite marked PVR reduction. CONCLUSIONS: In this preliminary retrospective case series, hypopressive physiotherapy was associated with substantial reductions in post-void residual volume in this small cohort. These findings from this preliminary case series support further prospective controlled studies.