Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Department of Urology, Division of Pediatric Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Neurourol Urodyn. 2021 Jan;40(1):404-411. doi: 10.1002/nau.24575. Epub 2020 Nov 18.
To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor-beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow-up.
A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups.
QoL scores, overall and day-time DVISS scores were significantly decreased in both sham and test groups (p < 0.05). In addition to these findings, the frequency of incontinence and urgency episodes were also significantly reduced (p < 0.05) in the TPTNS treatment group. This effect in the test group was still valid 2 years after intervention. There was no significant difference in UBs measurements between treatment and nonsymptomatic groups and between pretreatment and posttreatment measurements of test and sham groups.
TPTNS is an efficient minimally invasive treatment in children with FVD who do not respond to medical treatment. TPTNS provides a significant improvement on episodes of frequency, episodes of incontinence, overall and day-time DVISS scores, and QoL scores. The effectiveness of treatment continues even at the end of the second year of intervention. UBs were not found to be predictive in terms of diagnosis and evaluating the treatment response.
评估经皮胫后神经刺激（TPTNS）治疗功能性排尿障碍（FVD）的疗效，并探讨尿生物标志物（UBs：神经生长因子、转化生长因子-β1 和金属蛋白酶组织抑制剂 2）在诊断和随访中的应用价值。
本前瞻性随机对照试验共纳入 44 名儿童。30 名有储存期功能障碍的儿童随机分为两组，其中 20 名对药物治疗无反应或不配合的儿童接受 TPTNS 治疗（实验组），10 名儿童接受 TPTNS 假治疗（假手术组），共治疗 12 周。14 名健康儿童作为无症状组。在治疗组中，治疗前后评估 UB 水平、排尿障碍和失禁评分系统（DVISS）、排尿日记和生活质量（QoL）评分。
假手术组和实验组的 QoL 评分、整体和日间 DVISS 评分均显著降低（p<0.05）。此外，实验组的尿急和失禁发作频率也显著减少（p<0.05）。治疗 2 年后，实验组仍有效。治疗组和无症状组之间以及实验组和假手术组之间的 UB 测量值均无显著差异，治疗前后测量值也无显著差异。
TPTNS 是一种治疗对药物治疗无反应的 FVD 儿童的有效微创治疗方法。TPTNS 可显著改善尿急、失禁发作、整体和日间 DVISS 评分以及 QoL 评分。即使在干预结束后的第 2 年，治疗效果仍持续存在。UBs 在诊断和评估治疗反应方面无预测价值。
