INTRODUCTION
Pediatric urology addresses disorders of the kidneys, bladder, urethra, and genitals including incontinence and enuresis in infants, children, and adolescents. This field differs significantly from adult urology in terms of diagnosis and management strategies [1,2]. Approximately 7% to 10% of school-aged children, between the ages of 4 and 16 years, experience urinary conditions such as recurrent urinary tract infections (UTIs) or incontinence. These conditions can adversely affect a child’s quality of life, thus leading to low self-esteem, negative body image, and difficulties with social interactions, with these symptoms being about 2.5 times more likely to have such impacts [3,4].
Incontinence-related symptoms require regular fluid intake, the establishment of consistent voiding habits, and appropriate treatment. However, younger children often find it challenging to manage these processes on their own [5]. Moreover, the psychosocial issues and externalized behaviors such as anger, defiance, aggression, and hyperactivity that result from these symptoms cha have detrimental effects on the physical and emotional well-being of families supporting children with UTIs [6,7].
Recently, serious games have been developed and applied across various fields by demonstrating their effectiveness in the medical domain. In particular, these games have shown promise in the management of pediatric cancer, mental health issues, and overall health maintenance [8-10]. However, their use in pediatric urology still remains limited. The Screening for Cognitive, Emotional, and Behavioral Problems Pediatric Symptom Checklist (PSC), indicates that 19.2% of school-aged children with urological conditions are at risk for psychosocial issues, a rate that surpasses the diagnostic criteria for significant behavioral problems in children with diabetes (20%), gastrointestinal disorders (14%), and neurological conditions (38%) [6]. This suggests a pressing need to integrate functional games into the management of urological conditions in pediatric patients. In this regard, the purpose of this paper is to provide the current applications of serious games in the field of pediatric urology and explore the potential benefits and future directions for their use in this field.
DEFINITION AND EFFECTS OF SERIOUS GAMES
Definition of Serious Games
A serious game is a game designed for purposes beyond entertainment by using game mechanics to engage users and achieve specific objectives including educational or therapeutic benefits. They blend elements of enjoyment with purposeful content to achieve a synergistic effect that enhances both engagement and learning [11,12]. The concept of serious games was first introduced in the 1970s by Clark Abt, who coined the term ‘Serious Games’ to describe these types of games [12-14]. Currently serious games are employed across various sectors, as outlined in Table 1 to demonstrate their versatility and growing impact in areas such as education, healthcare, and training.
Effectiveness of Serious Games
Serious games have proven to be highly effective for adults, and their benefits are even more pronounced for children [3,15]. With the widespread use of computers and smart devices, the time spent playing digital games among pediatric and adolescent populations has significantly increased. In this regard, incorporating serious games into therapy for pediatric patients possibly can offer advantages over traditional face-to-face consultations with physicians [15,16]. These games leverage the engaging aspects of video games to enhance disease management and improve treatment adherence. The positive effects of functional gaming are summarized in Table 2 [17,18].
APPLICATIONS AND EFFECTS OF SERIOUS GAMES IN HEALTHCARE
Recently, serious games have gained traction in the medical field due to their ability to motivate and actively engage users, thereby enhancing treatment adherence and continuity [3]. These games effectively create environments conducive to physical rehabilitation and medical training while also positively influencing sociopsychological aspects such as self-efficacy, treatment intention, and anticipated outcomes [19,20]. Previous reviews and studies emphasize the growing integration of serious games in healthcare. Their applications are categorized by purpose and form as shown in Table 3, which illustrates their diverse roles and benefits across various medical contexts.
Table 4 summarizes previous reviews and studies on serious games in healthcare, clearly demonstrating their medical benefits. Randomized controlled trials with real patients confirm that serious games are highly effective across various health and medical contexts. These studies indicate that serious games positively impact the health and quality of life for patients with diverse medical conditions, including chronic diseases [21,22].
Despite their broad application in therapeutic settings, serious games are underutilized in urology, especially pediatric urology. As shown in Table 5 [1,8,9,12,15-17,23-35], the limited applications and research in the field of urology highlight a significant opportunity to expand the use of serious games in pediatric urology.
MEDICAL APPLICATOINS AND EFFECTIVENSS OF SERIOUS GAMES IN PEDIATRIC AND ADOLESCENT POPULATOINS
Pediatric Cancer
For pediatric cancer patients, continuous and regular self-management of chemotherapy, radiation therapy, and medication is crucial. Patients often face side effects such as infections, nausea, vomiting, and other complications. The challenges of longterm hospitalization and treatment require significant pain tolerance and patience. To address these challenges, serious games have been introduced to motivate patients and improve their adherence to treatment regimens [36,37].
Re-Mission
In Re-Mission, the user takes on the role of a nanorobot navigating the human body to combat threats like cancer cells, bacteria, tumors, and carcinogens. As shown in Table 6, the game requires players to choose and deploy therapeutic weapons, such as radiation, anti-inflammatory drugs, and anticancer medications, to halt the spread of cancer cells. Through this interactive experience, pediatric cancer patients gain insights into chemotherapy and drug effects within their own bodies [37-39]. Studies have shown that after engaging with these games, 70% of cancer patients acquired relevant knowledge more rapidly, followed complex medication regimens more accurately, and increased their antibiotic intake by 16% [1].
Kimo
Kimo is a virtual reality interactive game that immerses players in a simulated hospital environment in which they can participate in routine activities such as taking medication, eating, and maintaining hygiene. By engaging in these realistic scenarios, patients can develop a better understanding of the cancer treatment process. This virtual experience is designed to reduce anxiety, enhance quality of life, and potentially improve treatment outcomes [31]. Detail information can be found in Table 7.
Child Psychiatric Disorders
The World Health Organization estimates that by 2030, mental illnesses such as depression, anxiety, eating disorders, psychosis, substance addiction, autism, and phobias will constitute the largest global disease burden [10]. The scarcity of specialists and services for mental health conditions, combined with the stigma that often prevents patients from seeking help, complicates treatment efforts. Serious games present a promising alternative for preventing, diagnosing, recognizing, monitoring, and treating mental illnesses due to their interactivity, accessibility, and potential to provide anonymity [10,22,26,40]. Below are examples of serious games for children designed to address mental illness.
Dr. Zoo
Needle phobia affects approximately 19% of children aged 4 to 6, often leading to fear and refusal of necessary injection therapy. As shown in Table 8, the serious game Dr. Zoo allows users to step into the role of a veterinarian in a virtual zoo, where they administer injections to sick animals and observe their recovery. This gameplay experience helps children alter their perception of needles and reduce their phobia [25].
Vil Du?!
Pediatric victims of sexual abuse often struggle to articulate their experiences due to limited vocabulary, expressive abilities, and feelings of shame, fear, and guilt. Vil Du?! is a serious game designed to facilitate nonverbal communication between children and therapists. By engaging in activities like dressing a character, children can express their experiences in a familiar, game-based therapy environment. This approach helps reduce tension and stress, enabling communication and interaction with therapists without the need for face-to-face meetings. Detail information can be found in Table 9.
APPLICATIONS OF SERIOUS GAMES AND NEW TECHNOLGIES IN PEDIATRIC UROLOGY
A study using the PSC on 600 pediatric patients revealed that approximately 15.2% exhibited sociopsychological difficulties. This indicates a need for mental health treatment in this population [6]. Among those with urinary-related symptoms such as dysuria and urinary incontinence, the prevalence of sociopsychological difficulties increased to 19.2%. Notably, pediatric patients with dysuria or single symptomatic incontinence were found to be approximately 2.5 times more likely to experience externalizing or attention problems compared to other subjects. These findings underscore the high risk of both physical and sociopsychological challenges in pediatric urologic patients and highlight the importance of active treatment and mental health follow-up [6,14]. Therefore, new technologies including artificial intelligence (AI) and the Metaverse are increasingly being utilized to achieve medical outcomes, and serious games are also emerging as a novel form of digital therapeutics.
Application of New Technologies in Pediatric Urology
AI is increasingly being utilized across various fields including medicine, where it plays a pivotal role in personalized medicine and diagnostic image analysis [41]. In urology, AI is used to automatically record and monitor patients’ urination activities with high accuracy (94.2%). Additionally, AI technologies such as machine learning, deep learning, and image processing are applied in the diagnostic process to more accurately identify and visualize pathological signs, such as atypical deformity patterns that may be difficult for the human eye to detect [42-44].
In addition, the Metaverse, a technology that merges virtual reality with physical reality to create three-dimensional stereoscopic images on a 2-dimensional screen or through a head mounted display (HMD), is recognized as an innovative tool that can enhance treatment outcomes through active patient participation. In the medical field, the Metaverse facilitates improved communication between doctors and patients by providing precise visualizations of human structures and anatomy [10,45]. Multiple users can simultaneously access a virtual operating room within the Metaverse, which allows for the exchange of opinions on medical education and treatment. The Metaverse is also being used as a digital therapeutic tool for cognitive behavioral therapy in neurological and psychiatric disorders, the management of chronic and severe diseases, and neurorehabilitation for conditions such as stroke and attention deficit disorder with hyperactivity [42,45].
New technologies including AI and the Metaverse are also being applied to pediatric urology. Through display devices such as HMDs connected to the Metaverse, pediatric patients and their caregivers can better understand complex medical terms and visualize anatomical defects, thereby improving communication with medical staff and aiding in treatment decision-making. The distraction therapy that uses virtual reality can enhance the treatment experience for pediatric patients who experience pain and anxiety during medical visits [45,46].
Application of Serious Games in Urology
The application of serious games in pediatric urology is still in its early stages, especially when compared to their more established use in pediatric cancer, mental health, and emerging technologies like AI and the Metaverse. Current examples are often not fully developed games but rather mobile applications with some game-like features or prototypes designed for research purposes. Despite this, several studies have shown that these games can have significant positive effects on both pediatric and general urological conditions [18,29].
This paper first examines serious games designed for adults with focus on their structure, trends, and production styles. It then extends the analysis to pediatric audiences in order to identify current trends within the broader category of serious games in urology.
IUPROST
IUPROST is a mobile-based application developed for male patients who have undergone surgery for prostate cancer. Its primary goal is to promote self-management and improve the quality of life for patients experiencing urinary incontinence. The application incorporates serious gaming elements into behavioral therapy exercises, making the process more engaging for users. A study on IUPROST showed clinically significant improvements in symptoms of involuntary urinary incontinence, with benefits such as reduced stress and enhanced exercise performance [47]. Detail information can be found in Table 10.
Time After Time
Time After Time is another serious game, designed as an interactive decision support tool for older men diagnosed with localized prostate cancer. The game aims to boost patient confidence by helping them understand the impact of different treatment options on their health-related quality of life (HRQoL). The research has demonstrated the educational effectiveness of this game-based tool in enhancing patient focus on HRQoL and increasing engagement in selecting symptom treatments [29]. Detail information can be found in Table 11.
Kegel Quest
As shown in Table 12, Kegel Quest is a serious game designed to aid in retraining the pelvic floor muscles, where players earn points and rewards by completing in-game missions and quests. The game has been shown to improve voiding dysfunction and constipation in children and adolescents. In a study involving pediatric urology patients with an average age of 7.2 years, 89%–100% of participants experienced significant improvements in symptoms such as bedwetting, daytime incontinence, constipation, and vitiligo. Additionally, 42% of the patients reported a reduction in post-void residual volume. By integrating biofeedback technology with serious gaming, users can visually and audibly monitor their muscle contractions and exercise performance so that it can help them learn the correct techniques and achieve effective symptom improvement [35].
UrScore
UrScore is an application developed for pediatric patients with bladder dysfunction to help them exercise core muscles and treat non-neurogenic bladder dysfunction. The app is designed to strengthen core muscles to improve bladder function and treat related disorders, utilizing a gamified format that allows users to earn points and track their performance as they complete exercises. It also includes features for setting new goals and is designed to be easily adaptable and engaging for children [48]. Detail information can be found in Table 13.
The Challenges of Applying Serious Games in Urology
The application of serious games in urologic care presents several challenges related to costs and resources. Developing these games requires significant financial investment, human resources, and ongoing efforts to validate their effectiveness, as well as maintaining the necessary hardware and software. The creation of serious games involves the organic collaboration of experts from various fields including urologists with specialized technical knowledge, game developers, and educational experts who provide guidance [49]. When integrating serious games into urological care, several barriers must be addressed. Technical issues such as accessibility and data management, personal challenges like understanding the game and managing excessive time and workload, and organizational obstacles including financial constraints, management support, policy establishment, and the need for collaboration all play crucial roles [50]. In addition, factors like the cognitive development of children, the organization of game mechanics such as controls and interfaces, and the duration of gameplay interaction must be carefully considered [51]. Moreover, the content of these games should be enriched with engaging elements like challenges and storytelling in order to maintain user interest and effectiveness [3].
CONCLUSIONS
This paper reviews the current use and potential impact of serious games in the field of urology with a focus on games that have been medically applied and shown to be effective. To this objective, the paper examines the definition and scope of serious games—those designed to combine training and education with an enjoyable experience. In the medical field, serious games are particularly valuable in helping patients with chronic conditions to better understand their illnesses, recognize treatment options, and develop consistent treatment habits. For pediatric patients, serious games are especially beneficial in helping them understand and adhere to long and often challenging treatment processes, thereby improving their outlook on recovery. These games not only enhance the sociopsychological wellbeing and quality of life of the patients but also have a positive effect on their caregivers.
Given the demonstrated medical benefits of serious games, their applications in pediatric urological treatment hold considerable promise. Treatment for urological conditions such as kidney disorders, bladder dysfunction, incontinence, sexual health issues, and enuresis in children often requires prolonged treatment processes, along with the development of regular bowel habits, consistent water intake, symptom comprehension, and sustained motivation—similar to the challenges faced in treating pediatric cancer and mental illnesses. Children with incontinence or urinary issues often experience social and psychological difficulties in daily life and in interactions with their peers. Repeated instances of these difficulties can lead to low self-esteem, a diminished quality of life, and significant externalizing behaviors. If a child does not fully understand or appreciate their condition, the treatment process can result in increased family conflict. Therefore, there is a compelling need to actively introduce and apply serious games in pediatric urology. Given that children and adolescents are generally more familiar with and have greater access to games, they are likely to be more receptive to therapeutic approaches that incorporate functional gaming. Through these games, children can naturally learn to manage their urinary symptoms, form healthy habits, and engage more effectively in the long-term treatment process.
PDF Links
PubReader
ePub Link
XML Download
Full text via DOI
Download Citation
Print
