Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran; Department of Physical Therapy, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
J Pediatr Urol. 2020 Feb;16(1):36.e1-36.e6. doi: 10.1016/j.jpurol.2019.10.004. Epub 2019 Oct 18.
Several studies have revealed that electrical stimulation is an effective modality for treatment of lower urinary tract (LUT) dysfunction via raising the capacity or compliance of the bladder or maybe by pelvic floor relaxation and reducing detrusor pressure as well.
This study aimed to assess the efficacy of transcutaneous interferential (IF) electrical stimulation on LUT symptoms as well as urine flow parameters in children with primary bladder neck dysfunction (PBND).
We reviewed the charts of all children with persistent LUT symptoms who underwent IF electrical stimulation between 2010 and 2017. Twenty-three neurologically and anatomically normal children (mean age: 7.7 years, range: 5-13) with LUT symptoms were included in this study. Children had different LUT symptoms such as hesitancy, straining, urinary incontinence and constipation with no sufficient response to medical treatment (α -blocker) for at least 6 months. IF electrical stimulation was performed for 15 sessions, two times per week. All children were symptomatic and had abnormal urine flow pattern with an electromyographic (EMG) lag time of more than 6 s on uroflowmetry with EMG. A voiding chart, uroflowmetry with EMG and kidney and bladder ultrasounds were performed before and after the treatment for all children. Maximum and average urine flow rates, EMG lag time and postvoid residual volume were analyzed. In addition, alpha blocker therapy was continued during IF therapy.
Mean maximum and average urine flow rates improved from 14.1 to 7.6-19.7 ml/s and 9.5 ml/s, respectively, while mean EMG lag time decreased from 11.7 to 5.2 s after the treatment (all P < 0.05). Also postvoid residual volume decreased significantly from 35.6 to 7.6 ml at the end of treatment courses.
Pelvic floor EMG lag time, a documented parameter on uroflowmetry with EMG, defined as the time from the start of pelvic floor relaxation during a volitional voiding effort (the first stage of normal voiding) to the start of urine flow. Results showed that IF therapy decreased pelvic floor EMG lag time in children with PBND. In addition, increase in mean maximum and average urine flow rates in our patients indicated that pelvic IF therapy and behavioral modification improved voiding dysfunction in most of the patients and probably decreased bladder neck activity during voiding. Future studies with larger sample size are needed to support this finding.
IF therapy appears safe, effective and reproducible in improvement of PBND in children.
多项研究表明，电刺激通过提高膀胱顺应性或容量，或通过放松盆底肌和降低逼尿肌压力，是治疗下尿路（LUT）功能障碍的有效方法。
本研究旨在评估经皮干扰（IF）电刺激对原发性膀胱颈功能障碍（PBND）患儿 LUT 症状和尿流参数的疗效。
我们回顾了 2010 年至 2017 年间接受 IF 电刺激的所有持续存在 LUT 症状的患儿的图表。本研究纳入了 23 例神经和解剖正常的患儿（平均年龄 7.7 岁，范围 5-13 岁），他们有不同的 LUT 症状，如犹豫、紧张、尿失禁和便秘，且对至少 6 个月的药物治疗（α-阻滞剂）无明显反应。IF 电刺激共进行 15 次，每周两次。所有患儿均有症状，尿流动力学检查显示肌电图（EMG）滞后时间超过 6 秒，且存在异常尿流模式。所有患儿均在治疗前后进行排尿图、EMG 尿流动力学和肾脏及膀胱超声检查。分析最大和平均尿流率、EMG 滞后时间和残余尿量。此外，在 IF 治疗期间继续进行α阻滞剂治疗。
治疗后，最大和平均尿流率分别从 14.1ml/s 改善至 7.6-19.7ml/s 和 9.5ml/s，EMG 滞后时间从 11.7s 降至 5.2s（均 P<0.05）。此外，治疗结束时残余尿量从 35.6ml 显著减少至 7.6ml。
盆底肌 EMG 滞后时间是 EMG 尿流动力学的一个已确定参数，定义为盆底肌松弛开始至尿流开始的时间（正常排尿的第一阶段）。结果表明，IF 治疗可降低 PBND 患儿的盆底肌 EMG 滞后时间。此外，本研究中患者最大和平均尿流率的增加表明，盆腔 IF 治疗和行为矫正改善了大多数患者的排尿功能障碍，可能降低了排尿过程中的膀胱颈活动。需要更大样本量的进一步研究来支持这一发现。
IF 治疗在改善儿童 PBND 方面安全、有效且可重复。
