Posterior Tibial Nerve Stimulation in Children with Lower Urinary Tract Dysfunction: A Mixed-Methods Analysis of Experiences, Quality of Life and Treatment Effect
Abstract
:1. Introduction
2. Materials and Methods
2.1. PTNS Treatment
2.2. Quantitative outcome: Treatment Response and Frequency Voiding Chart Parameters
2.3. Quantitative Outcome: Quality of Life
2.4. Statistical Analysis of Quantitative Outcomes
2.5. Qualitative Outcome: Experiences of Children and/or Parents with PTNS
2.6. Ethical Considerations
3. Results
3.1. Quantitative Outcomes
3.1.1. Treatment Response and Frequency Voiding Chart Parameters
3.1.2. Quality of Life
3.2. Qualitative Outcomes
3.2.1. Experiences of Children and/or Parents
3.2.2. Decision to Choose PTNS and Expectations
“All those other options were more surgery-like. I didn’t like that very much. The only thing I thought acceptable was an injection in the leg. We think that is better than an operation”.Child P5 (6 years)
“We would have done anything to get her off that medication”.Mother P7
“Yes, I assume everyone with the same problem as us, would try anything to solve the problem so I thought let’s give it a try and hopefully it will help”.Mother P10
“Well, to be honest I thought, I just assume it doesn’t help, that way it can only be better than expected. That was our starting point. So, yes, no harm, no foul”.Mother P11
3.2.3. Time Investment
“[…] in the end it was quite tough. Every Friday. For half a year afterwards, [father] and I, would say, ‘ah we do not have to go to the hospital anymore’. Because we had to, say, leave between 12 and 12.30, eh, and you were back home at 4 or 5 o’clock. And you constantly got stuck in traffic”.Mother P9
“He was really disappointed not being able to meet with friends that period as it was normally my day off”.Mother P10
“As such, I do think that if, if it’s at home, it will make it easier. That we do not have to go to the hospital all the time and that won’t take as many hours of our time”.Child P8 (12 years)
3.2.4. Practical Aspects of PTNS
“When they put the needle in, it doesn’t hurt, but sometimes if they turn it on a bit too hard, it does hurt a little”.Child P4 (9 years)
“I think the first two or three times you were quite tense but now it’s like a walk in the park, isn’t it?”Mother P7
“Sometimes it is quite relaxing, quite often actually because you can’t do anything at all; just read a book or something like that […]”.Child P4 (9 years)
3.2.5. Group Setting/Talking about LUTD
“My only friend is [name friend] and she won’t tell anyone. […] because I’m afraid that everyone will know and then they will laugh at me”.Child P5 (6 years)
“[…] I now notice that she quickly responds that everything is fine. ‘I don’t have any accidents anymore. I’ve been dry for an entire week.’ Even though that is not the case. I think that is partly due to […] that she simply prefers not to answer such questions. […] and that this is the quickest way to stop the questions”.Mother P2
“I mainly think that just talking about it, makes it a subject that you can simply discuss with whoever is around at the moment and that it is not something you only discuss at home, so to speak”.Mother P4
“[…] then at least I’m one hundred percent sure I’m not the only one”.Child P3 (10 years)
“And for me, as a mother, that was very comforting, that I thought ‘Ah, I see’ her son was 12 at that time, so they were a lot further along in the trajectory. And they only had the treatment for the nights left. So that’s when I thought ‘Ah, yes, there is a light at the end of the tunnel somewhere, and it can get better’”.Mother P10
“That girl was just very relaxed and that made me feel a little more relaxed too”.Child P3 (10 years)
“I appreciated not being all alone in a room and it was also kind of cozy”.Child P9 (9 years)
“And I have to say that I was also very curious about, well curious… yes, […] you think ‘Oh, maybe I can talk to someone once to get a little confirmation, a little recognition from each other”.Mother P10
“[…] recently there was a child who came for the very first time and who was clearly nervous and I could see the parents were apprehensive too, and for a minute I thought, maybe I should, well, you know we’re in this together and to just tell them not to worry and that it will be okay and I didn’t mention it because I thought, well, it kind of feels like an intrusion into their own affair”.Mother P5
“Usually once you’re talking, the conversation runs its course. But perhaps they could also play a role when it comes to that. To try to loosen up the parents a little”.Mother P10
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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FVC ** | Baseline | After PTNS | p-Value |
---|---|---|---|
Average voided volume in mL (Median/25th–75th Quartiles) | 114 (77–150) | 139 (100–175) | 0.000 |
Maximum voided volume (Median/25th–75th Quartiles) | 192 (130–240) | 205 (150–250) | 0.025 |
Treatment response | |||
Complete response (100% cure) | 10% | ||
Partial response (50–99% improvement) | 32% | ||
50–80% improvement | 23% | ||
81–99% improvement | 9% | ||
No response (0–49% improvement) | 58% |
Total Score (Median/25th–75th Quartiles) | Baseline | After PTNS | p-Value |
---|---|---|---|
Child (N = 46) | 25 (20–41) | 19 (14–26) | 0.001 |
Parent(s) (N = 46) | 26 (18–38) | 22 (11–30) | 0.001 |
No Response * | Partial Response * | Complete Response * | ||||
T0 | T1 | T0 | T1 | T0 | T1 | |
Child | 24 (19–24) | 18 (14–18) | 32 (22–44) | 23 (16–32) | 23 (16–37) | 13 (6–13) |
Parent(s) | 23 (20–31) | 22 (12–31) | 22 (18–38) | 22 (16–30) | 36 (18–44) | 22 (5–27) |
Characteristics | Child | Parent | |
---|---|---|---|
Gender | Male | 5 (45%) | - |
Female | 6 (55%) | 11 (100%) | |
Age (child) | 6–8 | 4 (36%) | |
9–12 | 7 (64%) | ||
Treatment duration before PTNS (years) | 0–3 | 6 (55%) | |
≥4 years | 5 (45%) | ||
Response to PTNS * | NR | 6 (55%) | |
PR/CR | 5 (45%) | ||
Stage of PTNS and time of interview | At the start | 2 (18%) | |
Halfway | 4 (36%) | ||
PTNS completed | 5 (45%) |
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De Wall, L.L.; Bekker, A.P.; Oomen, L.; Janssen, V.A.C.T.; Kortmann, B.B.M.; Heesakkers, J.P.F.A.; Oerlemans, A.J.M. Posterior Tibial Nerve Stimulation in Children with Lower Urinary Tract Dysfunction: A Mixed-Methods Analysis of Experiences, Quality of Life and Treatment Effect. Int. J. Environ. Res. Public Health 2022, 19, 9062. https://doi.org/10.3390/ijerph19159062
De Wall LL, Bekker AP, Oomen L, Janssen VACT, Kortmann BBM, Heesakkers JPFA, Oerlemans AJM. Posterior Tibial Nerve Stimulation in Children with Lower Urinary Tract Dysfunction: A Mixed-Methods Analysis of Experiences, Quality of Life and Treatment Effect. International Journal of Environmental Research and Public Health. 2022; 19(15):9062. https://doi.org/10.3390/ijerph19159062
Chicago/Turabian StyleDe Wall, Liesbeth L., Anna P. Bekker, Loes Oomen, Vera A. C. T. Janssen, Barbara B. M. Kortmann, John P. F. A. Heesakkers, and Anke J. M. Oerlemans. 2022. "Posterior Tibial Nerve Stimulation in Children with Lower Urinary Tract Dysfunction: A Mixed-Methods Analysis of Experiences, Quality of Life and Treatment Effect" International Journal of Environmental Research and Public Health 19, no. 15: 9062. https://doi.org/10.3390/ijerph19159062