title: Posterior tibial nerve stimulation vs parasacral transcutaneous neuromodulation for overactive bladder in children.
abstract: OBJECTIVE
  Parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation have emerged as effective methods to treat overactive bladder in children. However, to our knowledge no study has compared the 2 methods. We evaluated the results of parasacral transcutaneous electrical nerve stimulation and posterior tibial nerve stimulation in children with overactive bladder.
  
  
  METHODS
  We prospectively studied children with overactive bladder without dysfunctional voiding. Success of treatment was evaluated by visual analogue scale and dysfunctional voiding symptom score, and by level of improvement of each specific symptom. Parasacral transcutaneous electrical nerve stimulation was performed 3 times weekly and posterior tibial nerve stimulation was performed once weekly.
  
  
  RESULTS
  A total of 22 consecutive patients were treated with posterior tibial nerve stimulation and 37 with parasacral transcutaneous electrical nerve stimulation. There was no difference between the 2 groups regarding demographic characteristics or types of symptoms. Concerning the evaluation by visual analogue scale, complete resolution of symptoms was seen in 70% of the group undergoing parasacral transcutaneous electrical nerve stimulation and in 9% of the group undergoing posterior tibial nerve stimulation (p = 0.02). When the groups were compared, there was no statistically significant difference (p = 0.55). The frequency of persistence of urgency and diurnal urinary incontinence was nearly double in the group undergoing posterior tibial nerve stimulation. However, this difference was not statistically significant.
  
  
  CONCLUSIONS
  We found that parasacral transcutaneous electrical nerve stimulation is more effective in resolving overactive bladder symptoms, which matches parental perception. However, there were no statistically significant differences in the evaluation by dysfunctional voiding symptom score, or in complete resolution of urgency or diurnal incontinence.
authors: Center for Voiding Disorders in Children (CEDIMI), Section of Pediatric Urology, Division of Urology, Bahiana School of Medicine, Salvador, Bahia, Brazil.
authors: Ubirajara
authors: U
authors: Barroso
authors: Walter
authors: W
authors: Viterbo
authors: Joana
authors: J
authors: Bittencourt
authors: Tiago
authors: T
authors: Farias
authors: Patrícia
authors: P
authors: Lordêlo
mesh_terms: D016009:Chi-Square Distribution; D002648:Child; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012447:Sacrum / Q000294:innervation*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000628:therapy*
keywords: DVSS; LUTS; OAB; PTNS; TENS; VAS; child; dysfunctional voiding symptom score; electric stimulation therapy; lower urinary tract symptoms; overactive bladder; posterior tibial nerve stimulation; transcutaneous electrical nerve stimulation; urinary bladder, overactive; urinary incontinence; visual analogue scale