Boudaoud Nadia, Binet Aurélien, Line Antoine, Chaouadi Dalila, Jolly Catherine, Fiquet Caroline Francois, Ripert Thomas, Merol Marie Laurence Poli
American Memorial Hospital Reims, France.
American Memorial Hospital Reims, France.
J Pediatr Urol. 2015 Jun;11(3):138.e1-10. doi: 10.1016/j.jpurol.2014.09.013. Epub 2015 Mar 31.
To assess the objective efficacy of transcutaneous posterior tibial nerve stimulation in children presenting with overactive bladder resistant to well conducted treatment.
This was a randomized, double-blind, controlled study on 20 children with OAB. All patients were previously treated with anticholinergic drugs associated with detrusor rehabilitation, diet advice, bladder-voiding hygiene and constipation treatment, with poor clinical results. Patients were randomized into two groups: -Group A: treatment with PTNS (n = 11). -Group B: sham treatment (n = 9). The program lasted 12 consecutive weeks with two 30-minutes sessions a week. Each patient underwent pre-stimulation urodynamic testing to validate bladder overactivity followed by a post-stimulation testing. Pre- and post-stimulation urodynamic parameters were compared in order to objectively evaluate the treatment's efficacy. The patients noted their incontinence episodes for 7 consecutive days in a diary before the beginning of the program, in the middle and at the end of it: this led to computing an incontinence score (score ranged from 0 to 13, from good to poor). The difference between the pre-stimulation and post-stimulation score enabled to express clinical results in terms of poor (less than a 3-point decrease), medium (a 3 to 5-point decrease), good (6 to 8-point decrease), very good (final score ranged between 0 and 3). Children were questioned regarding their impression of being stimulated or not.
In Group A, there were five very good clinical results (45%), one medium (10%) and five poor results (45%). In group B, nine very good results (66%) and three poor results (33%) were noted. Regarding urodynamic testing, volume voided during urgency (184 mL to 265 mL), maximal cystomanometry volume (215 mL to 274 mL) and volume at the onset of the first overactive detrusor contraction (ODC) (48 mL to 174 mL) were significantly increased in Group A (p = 0.002, p = 0.024 and p = 0.001) and maximal bladder pressure during ODC had decreased (61 to 46) (p = 0.042). 85% children in group A thought they were being stimulated vs. 70% in group B.
Even though we noticed urodynamics improvements in group A, which objectively supports the efficacy of TCTPNS, clinical results remained the same between the two groups. In spite of the small size of our sample, this underlines the placebo effect of any type management in this pediatric population. Studying precisely the maximal useful voltage and duration of stimulation should then be relevant in order to yield maximal benefits from this easy-to-use procedure.
评估经皮胫后神经刺激对膀胱过度活动症且规范治疗无效的儿童的客观疗效。
这是一项针对20名膀胱过度活动症儿童的随机、双盲、对照研究。所有患者此前均接受过抗胆碱能药物治疗，并辅以逼尿肌康复训练、饮食建议、膀胱排尿卫生指导及便秘治疗，但临床效果不佳。患者被随机分为两组：A组：经皮胫后神经刺激治疗（n = 11）。B组：假治疗（n = 9）。该方案持续12周，每周两次，每次30分钟。每位患者在刺激前进行尿动力学检测以确认膀胱过度活动，然后进行刺激后检测。比较刺激前后的尿动力学参数，以客观评估治疗效果。患者在方案开始前、中期和末期连续7天在日记中记录尿失禁发作情况：由此计算尿失禁评分（评分范围为0至13分，从好到差）。刺激前和刺激后评分的差值用于以差（下降少于3分）、中（下降3至5分）、好（下降6至8分）、非常好（最终评分在0至3分之间）来表示临床结果。询问儿童是否感觉受到了刺激。
A组有5个非常好的临床结果（45%），1个中等结果（10%）和5个差的结果（45%）。B组有9个非常好的结果（66%）和3个差的结果（33%）。关于尿动力学检测，A组尿急时排尿量（从184毫升增至265毫升）、最大膀胱测压容量（从215毫升增至274毫升）和首次逼尿肌过度活动收缩（ODC）开始时的容量（从48毫升增至174毫升）显著增加（p = 0.002，p = 0.024和p = 0.001），且ODC期间最大膀胱压力下降（从61降至46）（p = 0.042）。A组85%的儿童认为自己受到了刺激，而B组为70%。
尽管我们注意到A组尿动力学有所改善，这客观上支持了经皮胫后神经刺激的疗效，但两组临床结果相同。尽管我们的样本量较小，但这凸显了该儿科人群中任何类型治疗的安慰剂效应。因此，精确研究最大有效电压和刺激持续时间对于从这种易于实施的治疗方法中获得最大益处应是有意义的。
