Percutaneous electrical stimulation for overactive bladder in children: a pilot study. Issue 1 (February 2019)

• Record Type: Journal Article
• Authors: Barroso, U.; de Azevedo, A.R.; Cabral, M.; Veiga, M.L.; Braga, A.A.N.M.
• Is Part Of: Journal of pediatric urology. Volume 15:Issue 1(2019)
• Page Start: 38.e1
• Page End: 38.e5
• Publication Date: 2019-02
• Subjects: Overactive bladder -- Child -- Percutaneous stimulation; DVSS Dysfunctional Voiding Scoring System -- ICCS International Children's Continence Society -- OAB Overactive bladder -- PENS Percutaneous electrical nerve stimulation -- PTNS Percutaneous tibial nerve stimulation -- TENS Transcutaneous electrical nerve stimulation -- UTI Urinary tract infection -- VAS Visual Analog Scale; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2018.10.001
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Purpose: 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. Materials and methods: 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 10 mA, as tolerated by the participant, but without reaching the motor threshold. Pulse width was 600 μs 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. Results: 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). Discussion: The theory behind this new method is that when skin impedance is overcome through the use of acupuncture needles and 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. Conclusions: 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. Figure Photographs showing the steps involved in parasacral PENS:(A) marking the first sacral vertebra;(B) identifying the position of S3, 2 cm below S1;(C) marking the position of S3;(D) positioning the acupuncture needle at S3;(E) positioning the contralateral needle;(F) connecting the cable grippers to the needles. The needle is inserted perpendicular to the skin deep enough to pierce the skin. PENS, percutaneous electrical nerve stimulation. Figure