Effect of sacral-root stimulation on the motor cortex in patients with idiopathic overactive bladder syndrome

Efficacy of posterior tibial nerve stimulation in the treatment of children with primary mono-symptomatic nocturnal enuresis

Background/Aims:

Primary monosymptomatic nocturnal enuresis is the most frequent (85%) type of enuresis in children. However, there is limited research on the effect of posterior tibial nerve stimulation on monosymptomatic nocturnal enuresis in children. This study investigated the effect of posterior tibial nerve stimulation on primary monosymptomatic nocturnal enuresis in children.

Methods:

This controlled exposure study was conducted using a pretest–posttest design between March and December 2014. Participants (n=80) were randomly distributed to two study groups (control and intervention) using block randomisation. Participants in the control group were given and instructed on how to use a bedwetting alarm in addition to medical treatment for 12 weeks, whereas participants in the intervention group received posterior tibial nerve stimulation in addition to medical treatment for 12 weeks. The frequency of nocturnal enuresis, maximum voided volume and quality of life were evaluated before and after treatment.

Results:

Comparative analysis between pre- and post-treatment data revealed significant differences in both groups across all measured variables (p<0.05), with significant improvements in all three outcome measures found in the intervention group. Post-treatment, the intervention group demonstrated decreased frequency of nocturnal enuresis and improved maximum voided volume and quality of life.

Conclusions:

Posterior tibial nerve stimulation is an effective and safe approach for the treatment of primary monosymptomatic nocturnal enuresis and control of bedwetting in children.

Constipation in children with isolated overactive bladders

OBJECTIVE

To evaluate the prevalence of constipation in children with isolated overactive bladder (IOAB) and no micturition complaints.

MATERIALS AND METHODS

A questionnaire was used to evaluate constipation in 51 children with IOAB, as well as in a control group of 74 children between the ages of 4 and 14 years. The Rome III criteria for children were used to assess constipation. IOAB was defined as the presence of symptoms such as urgency with or without daytime incontinence or frequency, a bell-shaped uroflow, and no post-residual urine.

RESULTS

Mean patient ages were 7.94 (±2.8) and 8.28 (±3.4) years in the OAB and control group, respectively (p = 0.54). Twenty-eight (54.9%) of the OAB group were girls, and 34 (45.9%) were girls in the control group (p = 0.32). More of the children with IOAB had constipation than those without urinary symptoms (54.9% vs. 29.7%, p = 0.005; or 2.87, 95% CI: 1.3-6.0). The results were statistically significant regarding the following Rome III criteria: "history of stool retention", "presence of painful or hard bowel movements", "the presence of a large fecal mass in the rectum" and "large diameter stools which may obstruct the toilet". Within the group with OAB, constipation was more common among males (p = 0.05). There was no association between the type of OAB symptoms and constipation. The average dysfunctional voiding symptom score was 9.76 (±4.1). Eleven children (21.6%) presented alterations on ultrasound. Girls with OAB presented more frequently with UTI than boys (18 vs. 10, p = 0.13).

CONCLUSION

This was the first comparative study with respect to constipation in children with IOAB and without urinary symptoms. Children with IOAB have a greater risk of having constipation compared to those with no urinary symptoms.

Electrical nerve stimulation for overactive bladder in children

Overactive bladder (OAB) is a urological condition that is frequently observed in children and requires treatment. Standard urotherapy is usually the first line of treatment; however, children with severe OAB do not respond to this therapy. Antimuscarinic drugs may be used, but complete resolution of symptoms with this medication is low. Studies, including two randomized clinical trials, have demonstrated that electrical nerve stimulation (ENS) can be used successfully for OAB in children. Electrodes have been placed in the genitals, anus, and intravesical area, and on the tibial posterior nerve, as well as used transcutaneously or implanted during a surgical procedure. This Review will discuss the use of ENS in children with OAB, with particular focus on the putative mechanisms of action, the different ENS techniques available, and clinical results for this therapy.

Treatment of non-monosymptomatic nocturnal enuresis by transcutaneous parasacral electrical nerve stimulation

OBJECTIVE

To evaluate the effectiveness of transcutaneous parasacral electrical stimulation (TCPSE) in the treatment of non-monosymptomatic nocturnal enuresis (NMNE). Also, we evaluated possible pretreatment predictors of TCPSE failure.

MATERIALS AND METHODS

Nineteen children diagnosed with NMNE who underwent TCPSE were studied prospectively. There were 6 boys and 13 girls with a mean age of 9.05 ± 3.153 years (range 5-17 years). The sessions were performed three times per week for a maximum of 20 sessions, for 20 min each and at a frequency of 10 Hz.

RESULTS

For eight children (42%) the nocturnal enuresis resolved, four (21%) presented a reduction in nocturnal episodes to less than one a week, six (32%) presented no change and one (5%) had increased frequency of NMNE. Symptoms present before treatment, such as daytime incontinence, frequency, constipation and occurrence of urinary tract infection, were not predictors of failure after TCPSE.

CONCLUSION

TCPSE can be an effective treatment for NMNE, but about a third of patients will need another kind of treatment. No pretreatment factor was determined that predicted TCPSE failure.

Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial

PURPOSE

We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children. We designed a prospective randomized trial with sham control for this evaluation.

MATERIALS AND METHODS

We prospectively randomized 25 girls and 12 boys with an average age of 7.6 years (range 4 to 12) into the test (active treatment) or sham (superficial scapular electrical stimulation) group. A total of 20 sessions, 20 minutes each (10 Hz) were performed 3 times weekly. The criteria used to evaluate the rate of success were 1) self-reported cure, or significant, mild or no improvement; 2) visual analogue scale (level of success 0 to 10); 3) percent improvement; 4) modified Toronto score; and 5) maximum voided volume, average voided volume and number of voids daily based on bladder diary entries. After completion of the 20 sessions controls who were not cured underwent active treatment.

RESULTS

A total of 21 patients in the test group and 16 in the sham group underwent treatment. Among the active treatment group 61.9% of parents reported cure. In the sham group no parent reported cure (p <0.001). Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group, while 1 parent in the sham group indicated a score of 9 (p = 0.002). Additionally 100% improvement was reported by 12 parents in the test group and no parent in the sham group. Toronto score improved significantly in the test group (p <0.001) and sham group (p = 0.008). However, the score was reduced more significantly in the test group compared to the sham group (p = 0.011). In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased. After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured.

CONCLUSIONS

This is the first known randomized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder.

Prospective study of transcutaneous parasacral electrical stimulation for overactive bladder in children: long-term results

PURPOSE

We evaluated the long-term success of transcutaneous parasacral electrical stimulation for overactive bladder in children.

MATERIALS AND METHODS

We prospectively evaluated children who underwent transcutaneous parasacral electrical stimulation for overactive bladder. All patients had symptoms of overactive bladder, bell curve in uroflowmetry and low post-void residual urine. The procedure was performed using a frequency of 10 Hz for 20-minute sessions 3 times weekly for a maximum of 20 sessions. Initial and long-term (more than 6 months) success rates were evaluated.

RESULTS

Transcutaneous parasacral electrical stimulation was performed in 36 girls and 13 boys with a mean age of 10.2 years (range 5 to 17). Mean followup was 35.3 months (range 6 to 80). Before treatment urgency, daytime incontinence and urinary tract infection were seen in 100%, 88% and 71% of cases, respectively. Initial success (full response) was demonstrated in 79% of patients for urgency, 76% for incontinence and 77% for all symptoms. Continued success was seen in 84% of patients for urgency, 74% for daytime incontinence and 78% for all symptoms. If the 30 patients with at least 2 years of followup were considered, treatment was successful in 73%. Recurrence of symptoms after a full response was seen in 10% of cases. Two of 33 patients (6%) with urinary tract infection before the procedure still had infection after treatment.

CONCLUSIONS

Transcutaneous parasacral electrical stimulation is well tolerated, and demonstrates short and long-term effectiveness in treating overactive bladder in children. Symptoms eventually will recur in 10% of patients.