Botulinum toxin: A potential alternative to current treatment of neurogenic and idiopathic urinary incontinence due to detrusor overactivity

Percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children: Is it effective?

Background

To assess the efficacy and durability of percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children.

Results

Twenty patients with a mean age of 7 ± 3.3 years were included in the study. Subjective success was found in 12 patients (60%) who considered their situation to be better and requested to continue therapy to maintain the response which was considered as a therapeutic success, while eight patients (40%) patients chose not to continue therapy because they did not have symptomatic improvement.

Conclusion

Posterior tibial nerve stimulation is an effective, minimally invasive method for treatment and is easily applied to induce improvement in overactive bladder symptoms and objective urodynamic changes with negligible side effects.

Is the use of parasympathomimetics for treating an underactive urinary bladder evidence-based?

An underactive urinary bladder (UUB), often occurring after surgery, can lead to urinary retention even in otherwise healthy people. We systematically reviewed published reports to determine whether the use of parasympathomimetic agents is warranted in patients with a UUB. Agents allegedly useful in treating UUB were identified from urology and pharmacology textbooks. A systematic search for randomized clinical trials in patients with UUB using these agents revealed 10 such studies. Controls typically received placebo or no treatment. While three studies reported statistically significant improvements relative to the control group, six did not and one even reported a significant worsening of symptoms. There was no evidence for differences between individual drugs, specific uses of such drugs, or in outcome measures. We conclude that the available studies do not support the use of parasympathomimetics for treating UUB, specifically when frequent and/or serious possible side-effects are taken into account.