title: Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence.
abstract: OBJECTIVE
  We studied the effect of transcutaneous electrical nerve stimulation in children with overactive bladder and treatment refractory daytime urinary incontinence.
  
  
  METHODS
  We recruited 27 children 5 to 14 years old with daytime urge incontinence refractory to timer assisted standard urotherapy and anticholinergics who had normal urinalysis, and unremarkable urinary tract ultrasound and physical examination. Study exclusion criteria were bladder underactivity, lower urinary tract obstruction, ongoing defecation disorders, lower urinary tract surgery and previous transcutaneous electrical nerve stimulation. After a 2-week run-in of standard urotherapy the children underwent natural fill ambulatory urodynamics to confirm detrusor overactivity. Subsequently they were randomly allocated to 4 weeks of 2 hours of daily active or placebo S2-S3 transcutaneous electrical nerve stimulation. The severity of incontinence and urgency, and 48-hour bladder diaries were recorded before randomization and during intervention week 4. Children withdrew from anticholinergics throughout the study period.
  
  
  RESULTS
  Two children were excluded from randomization due to urodynamic signs of lower urinary tract obstruction. After 4 weeks of intervention 8 children (61%) in the active group showed a significant decrease in incontinence severity but this occurred in only 2 (17%) in the sham treated group (p <0.05). The active group had a significantly greater decrease in daily incontinence episodes compared to the sham treated group (p <0.01). Transcutaneous electrical nerve stimulation did not alter maximal and average voided volumes.
  
  
  CONCLUSIONS
  Sacral transcutaneous electrical nerve stimulation seems superior to placebo for refractory daytime incontinence in children with overactive bladder. This effect does not seem to be a consequence of improved bladder reservoir function.
authors.affiliation: Institute of Clinical Medicine, Aarhus University Hospital, Skejby, Aarhus, Denmark. hagstroem@ki.au.dk
authors.forename: Søren
authors.initials: S
authors.lastname: Hagstroem
authors.forename: Birgitte
authors.initials: B
authors.lastname: Mahler
authors.forename: Bodil
authors.initials: B
authors.lastname: Madsen
authors.forename: Jens Christian
authors.initials: JC
authors.lastname: Djurhuus
authors.forename: Søren
authors.initials: S
authors.lastname: Rittig
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D004561:Transcutaneous Electric Nerve Stimulation; D053202:Urinary Incontinence, Urge / Q000628:therapy*