Department of Paediatric Surgery and Urology, Children's Health, Dublin, Ireland.
School of Mathematics and Statistics, University College Dublin, Dublin, Ireland.
Neurourol Urodyn. 2022 Nov;41(8):1659-1669. doi: 10.1002/nau.25039. Epub 2022 Sep 7.
Nocturnal enuresis (NE) is a common pathology in children that can have significant behavioral, emotional, and social impacts on a child's life. Recent studies have assessed PTENS as a potential treatment method for NE, particularly in those who do not respond to initial first-line treatments. Literature has shown varying results with regard to its success. There has been no systematic review and meta-analysis to date assessing outcomes following this treatment.
Despite multiple studies showing the potential benefits of PTENS in NE, there has been no consensus regarding its efficacy. The aim of this study was to systematically analyze the effects of PTENS on children with NE.
In September 2021, a search of PubMed, Embase and the Cochrane Library was carried out for studies relating to outcomes following PTENS in children with NE. Studies included were original publication English language randomized controlled trial (RCT's) with at least ten children receiving parasacral transcutaneous electrical nerve stimulation (PTENS). After assessing for relevant studies, data were collated and analyzed from the included studies. Risk of bias was assessed using the Cochrane seven domain assessment. Our primary outcome was response and nonresponse to treatment. These results were combined in a fixed effects meta-analysis model to obtain an overall estimate of the success rate. Information regarding demographics was also collected. There was no external funding for this review.
Of 145 studies found initially, four RCT's (208 children) were included. The weighted mean rate of full response to active PTENS was 10.8% (0%-19%). All studies considered, meta-analysis showed no difference between PTENS and controls (RR: 0.70, 95% confidence interval [CI: 0.37-1.32]). Subgroup analysis of monosymptomatic enuresis showed no effect of PTENS compared to controls (RR = 0.58, 95% CI: [0.24-1.42]). When grouped, studies comparing PTENS to sham/behavioral treatment showed no benefit compared to controls (RR = 0.81, 95% CI: [0.05-12.53]) and those comparing PTENS to biofeedback/interferential current (IFC) showed no difference to controls (RR = 0.69, 95% CI: [0.36-1.33]). There was no evidence of a difference between cases and controls between these latter subgroups (RR = 0.70, 95% CI: [0.37-1.32]).
DISCUSSION/CONCLUSION: Our results suggest that PTENS has no clear benefit in the management of children with NE compared to controls. Subgroup analysis showed that its use in monosymptomatic NE has no clear advantage. However, this review has highlighted the need for further high quality studies. Limitations to this review included a relatively small sample size and the use of prior or concomitant therapies.
遗尿症（NE）是儿童常见的一种病理，会对儿童的生活产生重大的行为、情感和社会影响。最近的研究评估了 PTENS 作为 NE 的一种潜在治疗方法，尤其是在那些对初始一线治疗没有反应的患者中。文献显示其成功率存在差异。目前尚无系统评价和荟萃分析来评估这种治疗方法的结果。
尽管多项研究表明 PTENS 在 NE 中的潜在益处，但对于其疗效尚未达成共识。本研究旨在系统分析 PTENS 对 NE 儿童的影响。
2021 年 9 月，对 PubMed、Embase 和 Cochrane 图书馆进行了检索，以寻找与 NE 儿童接受 PTENS 治疗后结果相关的研究。纳入的研究为接受过经皮骶旁神经电刺激（PTENS）的原始发表的英语随机对照试验（RCT），至少有 10 名儿童接受了该治疗。在评估相关研究后，从纳入的研究中收集和分析数据。使用 Cochrane 七域评估法评估偏倚风险。我们的主要结局是治疗的反应和无反应。这些结果被合并到固定效应荟萃分析模型中，以获得成功率的总体估计。还收集了有关人口统计学的信息。本综述没有外部资金支持。
最初发现的 145 项研究中，有 4 项 RCT（208 名儿童）被纳入。积极 PTENS 完全反应的加权平均率为 10.8%（0%-19%）。所有考虑的研究，荟萃分析显示 PTENS 与对照组之间没有差异（RR：0.70，95%置信区间[CI：0.37-1.32]）。单症状遗尿症的亚组分析显示，PTENS 与对照组相比没有效果（RR=0.58，95%CI：[0.24-1.42]）。将 PTENS 与假/行为治疗进行分组比较时，与对照组相比，没有显示出益处（RR=0.81，95%CI：[0.05-12.53]），而将 PTENS 与生物反馈/干扰电流（IFC）进行比较时，与对照组相比没有差异（RR=0.69，95%CI：[0.36-1.33]）。这些亚组之间的病例与对照组之间没有差异（RR=0.70，95%CI：[0.37-1.32]）。
讨论/结论：我们的结果表明，与对照组相比，PTENS 在 NE 儿童的管理中没有明显的益处。亚组分析显示，其在单症状 NE 中的应用没有明显优势。然而，本综述强调了需要进一步开展高质量的研究。本综述的局限性包括样本量相对较小，以及使用先前或同时的治疗方法。
