title: Role of posterior tibial nerve stimulation in the treatment of refractory monosymptomatic nocturnal enuresis: a pilot study.
abstract: OBJECTIVE
  We evaluated the early clinical and urodynamic results of posterior tibial nerve stimulation in patients with refractory monosymptomatic nocturnal enuresis.
  
  
  METHODS
  We randomly assigned 28 patients with refractory monosymptomatic nocturnal enuresis to 2 equal groups. Group 1 received a weekly session of posterior tibial nerve stimulation for 12 weeks and group 2 was the placebo group. Evaluation was performed in each group at baseline and after posterior tibial nerve stimulation to compare clinical and urodynamic findings. Another clinical assessment was done 3 months after the first followup.
  
  
  RESULTS
  The 2 groups were comparable in baseline clinical and urodynamic data. Overall, 13 patients (46.4%) had detrusor overactivity and 14 (50%) had decreased bladder capacity. After treatment 11 group 1 patients (78.6%) had a partial or full response to posterior tibial nerve stimulation but only 2 (14.3%) in group 2 had a partial response (p = 0.002). Also, the average number of wet nights in group 1 was significantly lower than at baseline (p = 0.002). All urodynamic parameters significantly improved in group 1. In contrast, the number of wet nights and urodynamic parameters did not change significantly in group 2. At 3-month followup the number of patients with a partial or full response in group 1 had decreased from 11 (78.6%) to 6 (42.9%). No change was evident in group 2.
  
  
  CONCLUSIONS
  Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis. However, deterioration in some responders with time suggests the need for maintenance protocols.
authors.affiliation: Urology Department, Tanta University Hospital, Tanta, El Gharbia, Egypt. aliraheem82@yahoo.com
authors.forename: Ali Abdel
authors.initials: AA
authors.lastname: Raheem
authors.forename: Yasser
authors.initials: Y
authors.lastname: Farahat
authors.forename: Osama
authors.initials: O
authors.lastname: El-Gamal
authors.forename: Maged
authors.initials: M
authors.lastname: Ragab
authors.forename: Mohamed
authors.initials: M
authors.lastname: Radwan
authors.forename: Abdel Hamid
authors.initials: AH
authors.lastname: El-Bahnasy
authors.forename: Abdel Naser
authors.initials: AN
authors.lastname: El-Gamasy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rasheed
mesh_terms: D000293:Adolescent; D002648:Child; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D016037:Single-Blind Method; D013979:Tibial Nerve