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Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation.
J Pediatr Urol. 2018 02; 14(1):54.e1-54.e6.JP

Abstract

BACKGROUND

Parasacral transcutaneous electrical nerve stimulation (TENS) has emerged as an effective treatment for overactive bladder (OAB) in view of its high success rates in improving lower urinary tract symptoms and constipation, with no direct side effects. However, the clinical characteristics associated with the outcomes remain to be established.

OBJECTIVE

The aim of this study was to evaluate potential predictors of outcome in children with OAB treated using parasacral TENS.

STUDY DESIGN

This was a prospective study of children with symptoms of isolated OAB, enrolled consecutively to the study and treated with parasacral TENS (figure). Isolated OAB was defined as the presence of urinary urgency with no signs of dysfunctional voiding. The symptoms were considered completely resolved when a patient's parents/guardians or the patients themselves reported a 100% improvement. Parasacral TENS was performed twice weekly for a total of 20 sessions of 20 min each at 10 Hz. The potential predictive factors evaluated were: sex, age, daytime incontinence, nocturia, a prior history of urinary tract infection, the presence of nocturnal enuresis, constipation and holding maneuvers.

RESULTS

Eighty-three patients with a mean age of 7.8 ± 2.8 years were included in the study. Complete resolution of symptoms was achieved in 47 (56.6%). Following parasacral TENS treatment, a significant response was reported in 96.4% of cases. Of the 55 patients with nocturnal enuresis, partial resolution was achieved in 30 cases (54.5%), with a statistically significant association between nocturnal enuresis and the patient's response to treatment (p < 0.004; OR = 4.4, 95% CI 1.5-12.5). No other factor was associated with response to treatment.

DISCUSSION

To the best of our knowledge, this association between nocturnal enuresis and failure to respond to parasacral TENS treatment for lower urinary tract dysfunction has not previously been reported. The identification of factors capable of predicting therapeutic failure may allow professionals to select those specific patients who would benefit from a multimodal approach in the treatment of this pathology, which has such a significant impact on the quality of life of affected patients.

CONCLUSIONS

Nocturnal enuresis was the only symptom associated with a poor outcome following parasacral TENS treatment in children with OAB.

Authors+Show Affiliations

Center for Urinary Disorders (CEDIMI), Bahiana School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil. Electronic address: anselmo.hoffmann@gmail.com.Center for Urinary Disorders (CEDIMI), Bahiana School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.Center for Urinary Disorders (CEDIMI), Bahiana School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.Center for Urinary Disorders (CEDIMI), Bahiana School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.Center for Urinary Disorders (CEDIMI), Bahiana School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

28974365

Citation

Hoffmann, Anselmo, et al. "Predictors of Outcome in Children and Adolescents With Overactive Bladder Treated With Parasacral Transcutaneous Electrical Nerve Stimulation." Journal of Pediatric Urology, vol. 14, no. 1, 2018, pp. 54.e1-54.e6.
Hoffmann A, Sampaio C, Nascimento AA, et al. Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation. J Pediatr Urol. 2018;14(1):54.e1-54.e6.
Hoffmann, A., Sampaio, C., Nascimento, A. A., Veiga, M. L., & Barroso, U. (2018). Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation. Journal of Pediatric Urology, 14(1), e1-e6. https://doi.org/10.1016/j.jpurol.2017.07.017
Hoffmann A, et al. Predictors of Outcome in Children and Adolescents With Overactive Bladder Treated With Parasacral Transcutaneous Electrical Nerve Stimulation. J Pediatr Urol. 2018;14(1):54.e1-54.e6. PubMed PMID: 28974365.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation. AU - Hoffmann,Anselmo, AU - Sampaio,Clara, AU - Nascimento,Ana Aparecida, AU - Veiga,Maria Luiza, AU - Barroso,Ubirajara, Y1 - 2017/09/08/ PY - 2017/04/18/received PY - 2017/07/30/accepted PY - 2017/10/5/pubmed PY - 2019/8/17/medline PY - 2017/10/5/entrez KW - Children KW - Incontinence KW - Lower urinary tract KW - Nocturnal enuresis KW - Overactive bladder KW - Transcutaneous electrical nerve stimulation SP - 54.e1 EP - 54.e6 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 14 IS - 1 N2 - BACKGROUND: Parasacral transcutaneous electrical nerve stimulation (TENS) has emerged as an effective treatment for overactive bladder (OAB) in view of its high success rates in improving lower urinary tract symptoms and constipation, with no direct side effects. However, the clinical characteristics associated with the outcomes remain to be established. OBJECTIVE: The aim of this study was to evaluate potential predictors of outcome in children with OAB treated using parasacral TENS. STUDY DESIGN: This was a prospective study of children with symptoms of isolated OAB, enrolled consecutively to the study and treated with parasacral TENS (figure). Isolated OAB was defined as the presence of urinary urgency with no signs of dysfunctional voiding. The symptoms were considered completely resolved when a patient's parents/guardians or the patients themselves reported a 100% improvement. Parasacral TENS was performed twice weekly for a total of 20 sessions of 20 min each at 10 Hz. The potential predictive factors evaluated were: sex, age, daytime incontinence, nocturia, a prior history of urinary tract infection, the presence of nocturnal enuresis, constipation and holding maneuvers. RESULTS: Eighty-three patients with a mean age of 7.8 ± 2.8 years were included in the study. Complete resolution of symptoms was achieved in 47 (56.6%). Following parasacral TENS treatment, a significant response was reported in 96.4% of cases. Of the 55 patients with nocturnal enuresis, partial resolution was achieved in 30 cases (54.5%), with a statistically significant association between nocturnal enuresis and the patient's response to treatment (p < 0.004; OR = 4.4, 95% CI 1.5-12.5). No other factor was associated with response to treatment. DISCUSSION: To the best of our knowledge, this association between nocturnal enuresis and failure to respond to parasacral TENS treatment for lower urinary tract dysfunction has not previously been reported. The identification of factors capable of predicting therapeutic failure may allow professionals to select those specific patients who would benefit from a multimodal approach in the treatment of this pathology, which has such a significant impact on the quality of life of affected patients. CONCLUSIONS: Nocturnal enuresis was the only symptom associated with a poor outcome following parasacral TENS treatment in children with OAB. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/28974365/Predictors_of_outcome_in_children_and_adolescents_with_overactive_bladder_treated_with_parasacral_transcutaneous_electrical_nerve_stimulation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(17)30313-3 DB - PRIME DP - Unbound Medicine ER -