Parasacral Transcutaneous Electrical Nerve Stimulation Research Articles

The Management of Children and Adolescents with Overactive Bladder Refractory to Treatment with Parasacral Transcutaneous Electrical Nerve Stimulation.

Although parasacral TENS (pTENS) has been employed in various centers, there is a lack of studies on how children with overactive bladder (OAB) respond after failing to complete pTENS sessions. This study aimed to describe and assess treatments for OAB in children who did not respond to pTENS. This retrospective case series examined patients aged 4-17 years. Patients were given subsequent treatment options, including: behavioral therapies; oxybutynin; imipramine; a combination of oxybutynin and imipramine; parasacral percutaneous electrical nerve stimulation (PENS); or a repeat course of pTENS. Outcomes were evaluated using the Dysfunctional Voiding Scoring System (DVSS) and the Visual Analogue Scale (VAS). Thirty children were included, with a median age of 7 years. Patients received one or more treatments. Of these, 70% underwent monotherapy. Among them, 57% experienced complete resolution of symptoms, 28% had partial resolution and were satisfied with the results, and 14% discontinued treatment. 30% out of the whole sample continued to experience bothersome symptoms. Complete response, according to initial subsequent, was achieved in: 54% with intensified behavioral therapies, 33% with oxybutynin, and 50% with imipramine alone. The median DVSS score decreased from 7.0 to 2.0 (p=0.025), while the median VAS score increased from 80 to 100 (p<0.001). Children with OAB refractory to pTENS who received structured subsequent treatments showed partial response in all cases, with complete symptom resolution in half of the patients. More intensive urotherapy, medications, or repeat pTENS in combination with oxybutinin can be effective for managing this challenging condition.

267 - Darifenacin versus Parasacral Transcutaneous Electrical Nerve Stimulation for Overactive Bladder Syndrome in Patients Infected With Human T-Cell Lymphotropic Virus 1 – Preliminary Results of a Randomized Clinical Trial

267 - Darifenacin versus Parasacral Transcutaneous Electrical Nerve Stimulation for Overactive Bladder Syndrome in Patients Infected With Human T-Cell Lymphotropic Virus 1 – Preliminary Results of a Randomized Clinical Trial

Immediate and continued results of parasacral transcutaneous electrical nerve stimulation in paediatric patients with overactive bladders

Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol. To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB. 57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48h frequency/volume (48hF/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy). After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p<0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p<0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p<0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p<0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes. A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS. The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation.

Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial

Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP. A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n=27) and Manual Therapy (MG; n=27) groups. TENS application was performed 2 sessions in a week for 20min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5×5cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used. The decrease in the episodes of incontinence was higher in the TG (p=0.037; p<0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p=0.683; p>0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p=0.001; p<0.01). Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.

Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction.

Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

At-home use of parasacral transcutaneous electrical nerve stimulation for pediatric voiding dysfunction: a randomized controlled trial to assess its safety and feasibility.

Treating pediatric voiding dysfunction involves behavioral changes that require significant time or medications that are often avoided or discontinued due to side effects. Using parasacral transcutaneous electrical nerve stimulation (PTENS) has shown to have reasonable efficacy, but the safety and feasibility of its off-label use for pediatric voiding dysfunction are not well-established. Concerns have also been raised over treatment adherence. In-home therapy might improve adherence compared with office-based therapy; however, no studies have evaluated in-home feasibility to date. This study aims to assess the safety and feasibility of off-label use of PTENS for pediatric voiding dysfunction. A single-institution prospective, randomized controlled study was conducted from March 2019 to March 2020. Participants aged 6-18 years diagnosed with voiding dysfunction, overactive bladder, or urinary incontinence were eligible for the study. Those with known neurologic disorders, implanted electrical devices, anatomic lower urinary tract abnormality, and recurrent urinary tract infections and those taking bladder medications were excluded. Children with primary monosymptomatic nocturnal enuresis were also excluded due to previous work suggesting a lack of efficacy. Participants were randomly assigned to receive 12 weeks of urotherapy alone (control) or urotherapy plus at-home PTENS treatment. Families were contacted weekly to assess for adverse events (AEs) and treatment adherence. The primary and secondary outcomes were safety, defined as the absence of AEs and treatment adherence, respectively. A total of 30 eligible participants were divided into two groups, with 15 participants in each arm. The median age was 9.4 years (interquartile range: 7.7-10.6). In total, 60% were male. Baseline demographics and urotherapy compliance were similar between the two groups. With PTENS use, two AEs were reported, including mild pruritus at the pad site and discomfort when removing pads, while no AEs were noted in the control group. In total, 60% of patients completed three 30-min sessions per week, and all participants were able to complete treatment sessions for at least 10 weeks, involving 30 min of PTENS treatment each time. This randomized controlled study confirms that at-home use of PTENS is feasible with reasonable treatment adherence and minimal AEs. Future collaborative, multi-institutional studies may better determine the efficacy of this treatment modality.

Quality of life and psychological aspects in children with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation - A prospective multicenter study

To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB). This international, multicenter, prospective cohort study involved individuals of 6-16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol. Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64±2.63 years were included. Median DVSS was 11 (range 6-13.5) and 3 (range 0-7), (p<0.001), and median ICIQ-CLUTS was 12 (range 9-14) and 9 (range 5.7-12), (p<0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9-59.7) to 39 (range 29-53.15) following treatment (p=0.04). Median total SDQ score before and after treatment was 17 (range 13.5-21) and 15 (range 12-21), respectively (p=0.939). Parasacral TENS was associated with a significant improvement in urinary symptoms and QoL; however, there was no change in psychological symptoms, as measured using the SDQ.

Assessing the outcomes of parasacral transcutaneous electrical nerve stimulation (PTENS) in the treatment of enuresis in children: A systematic review and meta-analysis of randomized control trials.

Nocturnal enuresis (NE) is a common pathology in children that can have significant behavioral, emotional, and social impacts on a child's life. Recent studies have assessed PTENS as a potential treatment method for NE, particularly in those who do not respond to initial first-line treatments. Literature has shown varying results with regard to its success. There has been no systematic review and meta-analysis to date assessing outcomes following this treatment. Despite multiple studies showing the potential benefits of PTENS in NE, there has been no consensus regarding its efficacy. The aim of this study was to systematically analyze the effects of PTENS on children with NE. In September 2021, a search of PubMed, Embase and the Cochrane Library was carried out for studies relating to outcomes following PTENS in children with NE. Studies included were original publication English language randomized controlled trial (RCT's) with at least ten children receiving parasacral transcutaneous electrical nerve stimulation (PTENS). After assessing for relevant studies, data were collated and analyzed from the included studies. Risk of bias was assessed using the Cochrane seven domain assessment. Our primary outcome was response and nonresponse to treatment. These results were combined in a fixed effects meta-analysis model to obtain an overall estimate of the success rate. Information regarding demographics was also collected. There was no external funding for this review. Of 145 studies found initially, four RCT's(208 children) were included. The weighted mean rate of full response to active PTENS was 10.8% (0%-19%). All studies considered, meta-analysis showed no difference between PTENS and controls (RR: 0.70, 95% confidence interval [CI: 0.37-1.32]). Subgroup analysis of monosymptomatic enuresis showed no effect of PTENS compared to controls (RR = 0.58, 95% CI: [0.24-1.42]). When grouped, studies comparing PTENS to sham/behavioral treatment showed no benefit compared to controls (RR = 0.81, 95% CI:[0.05-12.53]) and those comparing PTENS to biofeedback/interferential current (IFC) showed no difference to controls (RR = 0.69, 95% CI: [0.36-1.33]). There was no evidence of a difference between cases and controls between these latter subgroups (RR = 0.70, 95% CI: [0.37-1.32]). Our results suggest that PTENS has no clear benefit in the management of children with NE compared to controls. Subgroup analysis showed that its use in monosymptomatic NE has no clear advantage. However, this review has highlighted the need for further high quality studies. Limitations to this review included a relatively small sample size and the use of prior or concomitant therapies.

Effectiveness of a Practical, At-Home Regimen of Parasacral Transcutaneous Electrical Nerve Stimulation in Pediatric Overactive Bladder

ObjectiveTo describe and evaluate efficacy of a more practical, at-home regimen of parasacral transcutaneous electrical nerve stimulation (TENS) for pediatric overactive bladder (OAB). MethodsWe prospectively enrolled patients with OAB. Inclusion criteria: age 5-13 years and willingness to try TENS. Exclusion criteria: urinary tract anatomic abnormalities, current use of OAB medications, neurologic condition, and elevated post-void residual. Patients were instructed to complete 20-minute sessions 2x/day for 1 month.Patients completed the Vancouver Symptom Score (VSS) and 48-hour frequency-volume chart before/after treatment. Compliance was assessed with a daily log. We recorded patient-reported improvement. Primary outcome was difference in VSS before/after treatment; secondary outcomes included: differences in frequency of voids/24 hours, max voided volume in 48 hours (%EBC), mean voided volume (%EBC), and mean number incontinence episodes/24 hours. ResultsWe enrolled 21 patients (3 male, 18 female; median age 9.9 years). We had complete VSS data on 17 patients and frequency-volume chart data on 12 patients. Median % of TENS sessions completed was 98%. 8/17 patients reported subjective improvement. There was a significant difference between pre- and post-TENS VSS (median score: 23 pre-TENS and 21 post-TENS, P = .009). There were no differences in secondary outcomes before/after treatment. ConclusionIn our cohort of medically-refractory OAB pediatric patients, nearly half reported subjective improvement with our regimen, despite modest objective improvement. Our compliance rates suggest this regimen is practical but may be best used as an adjunct to other therapies.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly.

ABSTRACTPurpose:This study compares the results achieved following parasacral TENS administered using two different weekly schedules.Materials and Methods:Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy.Results:Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment.Conclusion:For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

Time until maximum flow rate uroflowmetry: A new parameter for predicting failure of transcutaneous electrical nerve stimulation (TENS) in treating children and adolescents with overactive bladder

To analyze uroflowmetry as a predictor of the outcome of treatment with parasacral transcutaneous electrical nerve stimulation (TENS) in patients with pure overactive bladder. Thirty-eight patients of 5-16 years of age were included in this prospective cohort study. All the patients had been seen at a referral clinic between 2006 and 2015. All had a diagnosis of pure overactive bladder and were treated with TENS. Parameters established at pretreatment uroflowmetry were evaluated, with patients then being separated into two groups based on their visual analogue scale (VAS) score immediately following TENS. The variables analyzed at uroflowmetry were: maximum flow rate, curve pattern (bell or tower-shaped), time until maximum flow and voided volume. The mean age of the children evaluated was 7.26 years (SD: 2.62) (95%CI: 6.4-8.13) and 73.7% were girls. No association was found between maximum flow rate, curve pattern (bell or tower-shaped) or voided volume and the complete resolution of symptoms following treatment. Nevertheless, a shorter time until maximum flow was associated with a greater likelihood of treatment failure. The time until maximum flow rate before treatment is a potential predictor of the outcome of TENS treatment.

Editorial Comment.

No AccessJournal of UrologyPediatric Urology1 Jun 2021Editorial CommentThis article comments on the following:Parasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: A Randomized Clinical Trial Luitzen A. Groen Luitzen A. GroenLuitzen A. Groen Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001579.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 205(6), p. 1791 Reference 1. : Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: a randomized controlled trial. J Pediatr Urol 2014; 10: 1100. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyFeb 2, 2021, 12:00:00 AMParasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: A Randomized Clinical Trial Volume 205Issue 6June 2021Page: 1791-1791 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luitzen A. Groen Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands More articles by this author Expand All Advertisement PDF DownloadLoading ...

Parasacral transcutaneous stimulation to treat overactive bladder in children

Overactive bladder is the second most frequent cause of bladder dysfunction, after enuresis, in childhood. Urotherapy and anticholinergics are the first treatment options. However, in recent years, parasacral transcutaneous electrical nerve stimulation has been proposed as an alternative treatment. Current studies show the potential and efficacy of said treatment in children. According to results, a 20-minute session at 10Hz should be performed once or twice a week, for a total of 20 sessions. It is essential for all healthcare professionals to be aware of this procedure, so that innovative care, based on the latest evidence, can be offered to patients.

Estimulación transcutánea parasacral para tratar la vejiga hiperactiva en niños

La vejiga hiperactiva es la segunda causa más frecuente de disfunción funcional vesical tras la enuresis en la infancia. La uroterapia y los anticolinérgicos son las primeras opciones de tratamiento. Sin embargo, en los últimos años se ha propuesto la estimulación neural eléctrica transcutánea parasacral como tratamiento alternativo. Los estudios actuales exponen el potencial y la eficacia de este tratamiento en niños. Según los resultados, se deben realizar un total de 20 sesiones de unos 20 minutos de duración a 10Hz, con una frecuencia de 1-2 sesiones semanales. Es fundamental trasmitir estos conocimientos a todos los profesionales sanitarios, con el objetivo de administrar cuidados novedosos basados en las últimas evidencias.

Parasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: A Randomized Clinical Trial.

Parasacral transcutaneous electrical nerve stimulation has been used to manage lower urinary tract symptoms refractory to standard urotherapy. Nevertheless, its actual effectiveness in treatment of bladder and bowel dysfunction remains to be established. We sought to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of children with bladder and bowel dysfunction. This was a randomized clinical trial conducted with children and adolescents of 5-17 years of age diagnosed with bladder and bowel dysfunction. Patients with neurological or anatomical abnormalities of urinary or digestive tracts, those unable to attend treatment sessions 3 times a week, individuals with diabetes mellitus or diabetes insipidus and those using anticholinergic drugs or laxatives were excluded from the study. The sample was divided into 2 groups: a control group submitted to standard urotherapy plus sham electrotherapy applied to the scapular region and a treatment group submitted to urotherapy plus parasacral transcutaneous electrical nerve stimulation. All the patients were submitted to 3, 20-minute electrotherapy (parasacral transcutaneous electrical nerve stimulation or sham) sessions/week for a total of 20 sessions. Forty patients were evaluated, 20 in the control group and 20 in the treatment group. Mean age (±standard deviation) was 8.4±2.8 years and 52.5% were male. In 15 patients (37.5%), rectal diameter was ≥3 cm. Lower urinary tract symptoms improved in both groups following treatment, with no statistically significant differences in Dysfunctional Voiding Scoring System score, lower urinary tract symptoms or uroflowmetry patterns between the groups. Intragroup evaluation showed a significant improvement in enuresis in the treatment group. There was a significant improvement in functional constipation post-intervention in treatment group compared to control group (70% vs 20%, p=0.004). Parasacral transcutaneous electrical nerve stimulation is effective for treatment of bladder and bowel dysfunction in children and adolescents, particularly insofar as functional constipation is concerned.

Comparing the outcomes of parasacral transcutaneous electrical nerve stimulationfor the treatment of lower urinary tract dysfunctionin children: A systematic review and meta-analysis of randomized controlled trials.

Despite published evidence in recent decades suggesting improvement in lower urinary tract symptoms (LUTS) with the use of parasacral transcutaneous electrical nerve stimulation (PTENS), no consensus guidelines for therapy exist. This study systematically reviews the literature to assess the effect of PTENS in children with LUTS. A database search conducted up to December 2019 included Medline, EMBASE, and the Cochrane Library. From the literature review, 6 randomized controlled studies (234 participants) comparing PTENS and standard treatment (urotherapy/anticholinergics) were considered. From each study, the success rates were available for PTENS and the control group. The ratio of success rates was computed-that is, the risk ratio (RR) and the risk difference (RD). The overall success rate with PTENS was 1.92 times that of children undergoing standard urotherapy alone (RR: 1.92, 95% confidence interval [CI: 1.02, 3.61]) and 1.56 for those undergoing either urotherapy alone or with pharmacotherapy (anticholinergics; RR: 1.56, 95% CI[1.04, 2.40]). No difference in the success rate was found when PTENS was used in patients failing previous treatment (urotherapy and pharmacological therapy; RR: 0.175, 95% CI[0.02, 1.45]). Current evidence suggests that PTENS is beneficial in children with LUTS. The chance of success is 1.92 times that of children undergoing standard urotherapy. However, in children who have failed urotherapy and pharmacological therapy, PTENS monotherapy has a limited role and should be an adjunct.Literature shortcomings included small numbers of patients, differing inclusion criteria, and PTENS protocols. A need exists for quality multicenter randomized controlled trials to prove the efficacy of PTENS in children with LUTS.

EMG biofeedback or parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction: A prospective and randomized trial.

Evaluate the efficacyof biofeedback and parassacral electric nerve stimulation (TENS) for the treatment of children with lower urinary tract (LUT) dysfunction. A prospective, randomized study was approved by our Hospital Ethics Committee. We enrolled 64 children, 43 girls and 21 boys, average age of 9.39 years. The initial evaluation consisted of history, physical examination, urine analyses, voiding diary, uroflow, and ultrasound. Dysfunction voiding symptom score (DVSS) questionnaires were applied pre- and post-treatment. The children were divided into two treatment groups independent of the predominant type of voiding dysfunction (dysfunctional or overactive bladder): biofeedback group and TENS group. The criteria for assessing the effectiveness of the techniques was the resolution of daytime and nighttime symptoms including urinary leakage, improvements in voiding diary, DVSS, and changes in uroflow. After 6 months, the children were reassessed with the same work-up of baseline. Regarding daytime symptoms, results for complete response were similar between the two groups (P = 0.483); 54.9% of children treated by the biofeedback group and 60.6% in the TENS group. The same have been observed in the nighttime incontinence with complete resolutions in 29.6% and 25%, respectively ( P = 0.461). Analyzing the voiding diary, uroflow and DVSS questionnaires both groups had significant improvement ( P = 0.001) after treatment. The biofeedback group required fewer sessions than TENS group, 10.9 and 18.1, respectively ( P < 0,001). Both biofeedback and the TENS are equally effective for treating non-neurogenic voiding dysfunction. Biofeedback seems to require a lower number of sessions to obtain similar results of the TENS.

Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

ObjectiveTo compare these managements focusing on the efficacy and safety to treat overactive bladder (OAB) in children through network meta-analysis (NMA). MethodsWe searched PubMed, Embase, the Cochrane Library Central Register of Controlled Trials (CENTRAL) and the reference lists up to May 1st, 2017. Data from eligible randomized controlled trails (RCT) studies including three different treatment options were extracted. The primary outcome was maximal voiding volume (MVV). We performed pairwise meta-analyses by random effects model and NMA by Bayesian model. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework to assess the quality of evidence contributing to each network estimate. ResultsSix RCTs (462 patients) comparing three different interventions fulfilled the inclusion criteria. A low risk of bias was shown for the majority of the study items. The results of NMA showed that compared with antimuscarinic drugs, Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV (mean difference [MD] = 58.50, 95% confidential interval [CI]: 45.95–69.52), followed by urotherapy group (MD = 21.03, 95% CI: 11.85–29.97). When it comes to the constipation, antimuscarinic drugs exerted significant benefit than PTENS (odds ratio [OR]: 0.22, 95% CI: 0.01–0.46). No significant difference was found between other treatments. ConclusionCompared with antimuscarinic drugs, PTENS was associated with significant better efficacy considering MVV, but more constipation events in de novo OAB children. Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy. Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.

Percutaneous electrical stimulation for overactive bladder in children: a pilot study

The purpose of this was to evaluate the efficacy (tolerance and safety) of once-a-week parasacral percutaneous electrical nerve stimulation (PENS) to treat overactive bladder (OAB) in children. This is a prospective case series of children aged 4-14 years who underwent PENS for OAB. Acupuncture needles were used bilaterally and symmetrically at S3 for sacral nerve stimulation (Figure). Eighteen children with pure OAB underwent PENS weekly for 20 weeks. Frequency was 10 Hz. Intensity varied up to a maximum of 10mA, as tolerated by the participant, but without reaching the motor threshold. Pulse width was 600μs Patients' voiding history was assessed before treatment using a structured questionnaire. The dysfunctional voiding scoring system (DVSS) was used before and after treatment to quantify symptoms of lower urinary tract dysfunction. A visual analog scale (VAS) was used to evaluate treatment outcome. Seven boys and eleven girls (mean age, 7.82±2.45 years) were included. According to the VAS, symptoms were resolved in 66% of patients. Urinary urgency, present in all children at baseline, was resolved in 84% (P=0.001). The proportion of patients with involuntary loss of urine without urgency decreased from 77% before treatment to 27% (P=0.04). Urge incontinence resolved in 13 of 16 patients after treatment (P=0.001). Only one of the 12 children with frequent urination at baseline reported this complaint after treatment (P=0.04). All cases of recurrent urinary tract infection were resolved (P=0.001). Regarding nocturnal enuresis, treatment was successful in 9 of 14 children (P=0.004). The theory behind this new method is that when skin impedance is overcome through the use of acupuncture needlesand greater proximity is attained between the tip of the electrode and the sacral nerves, a more effective stimulus is achieved, with enough energy to provide the same benefits as parasacral transcutaneous electrical nerve stimulation with the advantage that treatment can be given only once a week. Percutaneous electrical nerve stimulation seems to be an effective and safe treatment for OAB over the short term. Furthers studies with a control group are needed.