Department of Paediatrics, Nephrology and Hypertension Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
Division of Physical Therapy Medical University of Gdansk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk Poland.
J Pediatr Urol. 2024 Oct;20(5):868-876. doi: 10.1016/j.jpurol.2024.07.006. Epub 2024 Jul 14.
Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol.
To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB.
57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48 h frequency/volume (48 h F/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1 h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy).
After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p < 0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p < 0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p < 0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p < 0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes.
A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS.
The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation.
在儿童日间遗尿的各种病因中，最常见的是膀胱过度活动症（OAB）。骶旁经皮神经电刺激（parasacral TENS）是治疗儿童 OAB 的一种有前途的方法；然而，目前还没有标准的治疗方案。
评估骶旁 TENS 单疗法对 OAB 患儿的即刻和持续疗效。
2013 年至 2018 年，在单一中心前瞻性纳入 57 名平均年龄为 10.8 岁的 OAB 患儿。纳入标准为典型 OAB 症状。根据膀胱日记、48 小时频率/体积（48 h F/V）图表和尿流率的客观测量来评估治疗结果。骶旁 TENS 治疗持续 4 个月，每日 2 次，每次 1 小时。结果在三个时间点进行评估：治疗 2 个月、4 个月（主动治疗结束）和 10 个月（治疗结束后 6 个月）。
骶旁 TENS 治疗 4 个月后，日间尿失禁天数从 7.23 天减少到 3.94/14 天（p<0.05），夜间遗尿从 6.81 天减少到 3.77/14 天（p<0.05），14 天内急迫性尿失禁次数从 7.36 次减少到 3.58 次（p<0.05）。治疗停止 6 个月后，日间尿失禁天数（从治疗后立即的 3.94 天到治疗停止后 6 个月的 3.28 天）、夜间遗尿（从 3.77 天到 2.91 天）和急迫性尿失禁次数（从 3.58 天到 2.12 天）仍保持稳定（p<0.05）。治疗 6 个月后，日间尿失禁、夜间遗尿和急迫性尿失禁完全缓解的患者比例分别为 32%、35%和 50%。
最近一项关于骶旁 TENS 治疗 OAB 儿童的系统评价仅包括两项研究，其治疗停止后随访时间超过 6 个月；因此，关于骶旁 TENS 的持续效果知之甚少。在仅评估主观症状的研究中，报告了较高的完全症状缓解率。本研究的结果表明，治疗的积极效果持续存在。本研究的优势包括前瞻性设计、样本量大、以及在 TENS 治疗前进行统一的标准尿动力学检查。
骶旁 TENS 治疗 OAB 患儿有效，可显著减少日间尿失禁、夜间遗尿和急迫性尿失禁。更长的 4 个月治疗时间可带来更多的改善，并且在治疗停止后 6 个月时效果仍保持稳定。
