Intravesical electrical stimulation in the treatment of micturition dysfunction in children.
OBJECTIVE
To evaluate the results of intravesical electrical stimulation (IVES) in an open prospective study to treat underactive detrusor in children. The treatment was offered as an alternative to clean intermittent catheterization (CIC).


METHODS
Forty-four children were included, 21 girls and 3 boys (6-16 years, md 10) with idiopathic, 9 girls and 11 boys (4-18 years; md 13) with neurogenic underactive detrusor. IVES was given by a catheter electrode in the bladder (cathode) with the anode attached to the suprapubic abdominal skin. Continuous stimulation at 20 or 25 Hz was delivered by battery powered stimulators giving unipolar square-wave pulses (0,2 or 0,7 ms). Stimulation intensity was adjusted individually according to the acceptance of the child (12-64 mA). IVES was initially given at the clinic but 18 children had additional treatment at home. Effect of treatment was monitored by micturiton/incontinence diary, reports of bladder sensation, recordings of urinary flow, residual volume and frequency of urinary tract infections.


RESULTS
The IVES-treatment was completed by 39/44 children. Long term normalization of the voiding (md 2,5 years follow up) was obtained for 20/24 children with idiopathic problems (83%) and 8/20 with neurogenic problems (40%). Another four had much improved bladder function. The neurogenic group required more stimulation sessions than the idiopathic group. Of those on CIC, 11/15 who completed IVES could discontinue the catheterization. The frequency of urinary tract infections and incontinence decreased significantly (P < 0.01).


CONCLUSIONS
It is concluded that IVES is a promising method to treat the underactive detrusor in children.
Gladh
Gunilla
G
Department of Molecular and Clinical Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping, Sweden. gunilla.gladh@lio.se
Mattsson
Sven
S
Lindström
Sivert
S
D000293:Adolescent; D002648:Child; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008465:Mechanoreceptors / Q000502:physiology; D009119:Muscle Contraction; D011446:Prospective Studies; D012677:Sensation; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation / Q000503:physiopathology; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*; D014552:Urinary Tract Infections / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics