Animated Biofeedback for Pediatric Functional Voiding Dysfunction: A Systematic Review and Meta-Analysis of Postvoid Residual Outcomes

Animated or gamified biofeedback has been introduced to improve engagement during pelvic floor retraining in children with functional voiding dysfunction. However, its incremental clinical benefit beyond standard urotherapy or conventional biofeedback remains uncertain. This systematic review aimed to synthesize available evidence on animated or gamified biofeedback for pediatric nonneurogenic functional voiding dysfunction, with exploratory quantitative analysis of postvoid residual (PVR) urine volume. A systematic search of PubMed, Cochrane Library, and ScienceDirect was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance. Comparative studies evaluating animated or gamified biofeedback in children with dysfunctional voiding, dysfunctional elimination syndrome, or nonneuropathic underactive bladder were included. PVR urine volume was pooled using a random-effects model when extractable data were available. Other outcomes were summarized narratively. Three comparative studies involving 170 children were included. Two studies compared animated biofeedback plus standard urotherapy with urotherapy alone, whereas one compared animated with nonanimated biofeedback. Exploratory meta-analysis showed no statistically significant reduction in PVR urine volume with animated or gamified biofeedback compared with control regimens (MD, -6.83 mL; 95% CI, -29.27 to 15.62; p = 0.55), with substantial heterogeneity (I² = 89%). Narrative findings suggested more favorable outcomes when biofeedback was added to urotherapy, but the direct comparison did not demonstrate clear superiority of animation over conventional biofeedback. The available evidence is limited by small sample size, heterogeneous diagnoses, inconsistent comparator structures, and imprecision. The pooled estimate should therefore be interpreted as exploratory rather than confirmatory. Current evidence is insufficient to confirm that animation or gamification provides additional therapeutic benefit beyond conventional biofeedback. Larger standardized comparative studies are needed.