de Paula Lidyanne Ilidia da Silva, de Oliveira Liliana Fajardo, Cruz Brysa Paiva, de Oliveira Dayana Maria, Miranda Laís Maini, de Moraes Ribeiro Mauro, Duque Raphaela Ornellas, de Figueiredo André Avarese, de Bessa José, Netto José Murillo Bastos
Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
Division of Urology, Department of Surgery, State University of Feira de Santana (UEFS), BA, Brazil.
J Pediatr Urol. 2017 Jun;13(3):263.e1-263.e6. doi: 10.1016/j.jpurol.2016.11.019. Epub 2016 Dec 21.
Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, and its main manifestation is urinary urgency. In general, urotherapy and anticholinergics are the first choices of treatment. Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative for the treatment of detrusor overactivity in children, but treatment protocols described to date require several sessions per week or long-lasting sessions, making it difficult for the child to adhere to the treatment. Thus, this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children.
This prospective, randomized controlled trial included 16 children with OAB. Children were divided into two groups: CG (urotherapy and electrical stimulation placebo) and EG (urotherapy and PTENS). For both groups, therapy was delivered in 20 weekly sessions, of duration 20 min each. Placebo electrical stimulation was done in the scapular area. The children were evaluated prior to treatment (T1), at the end of the 20 sessions (T2), and 60 days after the completion of treatment (T3), with a 3-day voiding diary, visual analogue scale (VAS), Rome III diagnostic criteria, and the Bristol Scale.
The groups were similar in age, gender, and ethnicity. In the initial assessment, all children, in both groups, had urgency and incontinence, 50% in each group had constipation, and enuresis was present in seven children (87.5%) in the EG and six (75%) in the CG. No differences were found between the groups regarding the volumetric measurements made in the voiding diary, urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale. Sixty days after treatment, a significant improvement was found in the EG group (p = 0.03) regarding urgency (Table), as well as an increase in dry nights in those presenting with enuresis (p = 0.03). No difference was noted regarding urinary incontinence (Table). At the end of 20 sessions and after 60 days of treatment, those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS (p = 0.05 and 0.04, respectively).
Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis, and in the perception of those responsible for the children. Further studies with larger populations are needed to corroborate these results.
膀胱过度活动症（OAB）是儿童中最常见的排尿障碍，其主要表现为尿急。一般来说，尿疗法和抗胆碱能药物是首选治疗方法。骶旁经皮神经电刺激（PTENS）被引入作为治疗儿童逼尿肌过度活动的替代方法，但迄今为止所描述的治疗方案需要每周进行几次治疗或长时间治疗，这使得儿童难以坚持治疗。因此，本研究旨在评估每周单次进行PTENS治疗儿童OAB的有效性。
这项前瞻性随机对照试验纳入了16名患有OAB的儿童。儿童被分为两组：CG组（尿疗法和电刺激安慰剂）和EG组（尿疗法和PTENS）。两组均进行20次每周一次的治疗，每次治疗持续20分钟。在肩胛区进行安慰剂电刺激。在治疗前（T1）、20次治疗结束时（T2）和治疗完成后60天（T3），使用3天排尿日记、视觉模拟量表（VAS）、罗马III诊断标准和布里斯托尔量表对儿童进行评估。
两组在年龄、性别和种族方面相似。在初始评估中，两组所有儿童均有尿急和尿失禁，每组50%的儿童有便秘，EG组7名儿童（87.5%）和CG组6名儿童（75%）有遗尿。在排尿日记中的尿量测量、根据罗马III标准和布里斯托尔量表评估的尿频和便秘方面，两组之间未发现差异。治疗60天后，EG组在尿急方面有显著改善（p = 0.03）（表），遗尿儿童的干爽夜晚次数增加（p = 0.03）。在尿失禁方面未发现差异（表）。在20次治疗结束时和治疗60天后，EG组儿童的家长认为VAS测量的症状有更大改善（分别为p = 0.05和0.04）。
我们的初步结果表明，每周单次进行PTENS对治疗膀胱尿急和遗尿症状以及儿童家长的感知是有效的。需要对更多人群进行进一步研究以证实这些结果。
