title: Transcutaneous parasacral electrical neural stimulation in children with primary monosymptomatic enuresis: a prospective randomized clinical trial.
abstract: OBJECTIVE
  Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis.
  
  
  METHODS
  This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months.
  
  
  RESULTS
  Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911).
  
  
  CONCLUSIONS
  Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.
authors.affiliation: Department of Surgery, Division of Urology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais (DMdO, LIdSdP, AAdF, CAdS, JMBN), Brazil; Department of Surgery, Division of Urology, State University of Feira de Santana, Feira de Santana, Bahia (JdB), Brazil.
authors.forename: Liliana Fajardo
authors.initials: LF
authors.lastname: de Oliveira
authors.forename: Dayana Maria
authors.initials: DM
authors.lastname: de Oliveira
authors.forename: Lidyanne Ilídia
authors.initials: LI
authors.lastname: da Silva de Paula
authors.forename: André Avarese
authors.initials: AA
authors.lastname: de Figueiredo
authors.forename: José
authors.initials: J
authors.lastname: de Bessa
authors.forename: Cacilda Andrade
authors.initials: CA
authors.lastname: de Sá
authors.forename: José Murillo
authors.initials: JM
authors.lastname: Bastos Netto
mesh_terms: D000293:Adolescent; D002648:Child; D004775:Enuresis / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D011446:Prospective Studies; D004561:Transcutaneous Electric Nerve Stimulation
keywords: CG; EG; ICCS; International Children's Continence Society; PTENS; behavior therapy; control group; electric stimulation therapy; enuresis; experimental group; parasacral transcutaneous electrical neural stimulation; transcutaneous electric nerve stimulation; urinary incontinence