Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trial
Introduction
Overactive bladder (OAB) is the most prevalent urinary disorder in childhood. Its main clinical feature is the presence of urinary urgency. Symptoms of incontinence, pollakisuria, and nocturia may or may not be present [1], [2]. Griffiths et al. (2005) demonstrated an association between poor bladder control and abnormal activation of the frontal cortex [3]. It is believed that a delay in developing cortical centers involved in controlling the bladder is responsible for causing involuntary detrusor contractions during filling, and these would be recognized as a sudden and irresistible desire to urinate [2], [4].
There is an intimate relationship between constipation and overactive bladder. It is believed that the increased fecal volume may trigger bladder contractions, besides reducing the functional capacity of the bladder [5]. Moreover, children with urinary urgency tend to inhibit this desire via retention maneuvers, which cause the retention of evacuation. Moreover, fecal retention increases bladder pressure, which leads to an increased urgency, recurrent urinary tract infections, and post-void residual urine [6].
Urotherapy is often the first line of treatment for these children. Adequate fluid intake, time voiding, treatment of constipation, orientation regarding posture to urinate, and avoiding retention maneuvers are among the behavioral changes that should be adopted [2], [7], [8]. Besides urotherapy, anticholinergic drugs are often used, but have significant side effects, especially constipation, which can lead to non-compliance or dropout from the treatment [9].
Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative method for treatment of children with detrusor overactivity who did not respond to previous treatments with anticholinergics. Early studies evaluating this method were conducted with daily sessions [10], [11]. Later, other authors evaluated PTENS with three sessions a week and found it to be safe and well tolerated, demonstrating effectiveness in the short- and long-term treatments of children with OAB [12], [13], [14]. However, travel from smaller urban areas to larger centers where the treatment is offered increases costs with transportation and demands, and increases time required for all the treatment sessions, which can reduce adherence to treatment or even prevent it from being carried out.
In an attempt to avoid such complications, the present study aimed at evaluating the feasibility and effectiveness of PTENS performed with single weekly sessions for treatment of OAB in children.
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Patients and methods
A controlled prospective randomized study was conducted, after being approved by the research ethics committee of our institution, including children aged 3–18 years of age with a clinical diagnosis of OAB not previously treated for this disease or having gone at least 6 months without any treatment, and whose parents signed the informed consent form. OAB was defined as the presence of urinary urgency with or without incontinence and not in the presence of urinary tract infection. Children with
Results
Sixteen children with clinical diagnosis of OAB were included in the study, with eight of them being randomly allocated to each group. The groups were similar in age, gender, and ethnicity and EBC (Table 1). Socioeconomic issues meant that two children (one from each group) found it difficult to attend the sessions and withdrew from the study.
No differences were found in any of the volumetric measurements assessed by the voiding diary (average voiding volume, average voiding volume per day, and
Discussion
The number of studies using PTENS to treat children with clinical diagnosis of OAB has grown over time, as it is considered to be an effective, non-invasive and easy to apply modality [15]. It is believed that neuromodulation produces a physiological effect, allowing remodeling of synapses through neuroplasticity mechanisms, possibly promoting neural definitive reconditioning [16]. Experimental studies in cats demonstrated that neuroelectrical stimulation of the sacral routes activates, through
Conclusions
Our preliminary results demonstrate that PTENS performed once a week, associated with urotherapy, is effective in treatment of OAB regarding its main clinical symptom (urinary urgency), the subjective perception of those responsible for the resolution of symptoms, and also decreasing the episodes of enuresis.
Funding
None.
Conflict of interest
None.
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