title: Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trial.
abstract: BACKGROUND
  Overactive bladder (OAB) is the most prevalent voiding disorder in childhood, and its main manifestation is urinary urgency. In general, urotherapy and anticholinergics are the first choices of treatment. Parasacral Transcutaneous Electrical Neural Stimulation (PTENS) was introduced as an alternative for the treatment of detrusor overactivity in children, but treatment protocols described to date require several sessions per week or long-lasting sessions, making it difficult for the child to adhere to the treatment. Thus, this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children.
  
  
  METHODS
  This prospective, randomized controlled trial included 16 children with OAB. Children were divided into two groups: CG (urotherapy and electrical stimulation placebo) and EG (urotherapy and PTENS). For both groups, therapy was delivered in 20 weekly sessions, of duration 20 min each. Placebo electrical stimulation was done in the scapular area. The children were evaluated prior to treatment (T1), at the end of the 20 sessions (T2), and 60 days after the completion of treatment (T3), with a 3-day voiding diary, visual analogue scale (VAS), Rome III diagnostic criteria, and the Bristol Scale.
  
  
  RESULTS
  The groups were similar in age, gender, and ethnicity. In the initial assessment, all children, in both groups, had urgency and incontinence, 50% in each group had constipation, and enuresis was present in seven children (87.5%) in the EG and six (75%) in the CG. No differences were found between the groups regarding the volumetric measurements made in the voiding diary, urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale. Sixty days after treatment, a significant improvement was found in the EG group (p = 0.03) regarding urgency (Table), as well as an increase in dry nights in those presenting with enuresis (p = 0.03). No difference was noted regarding urinary incontinence (Table). At the end of 20 sessions and after 60 days of treatment, those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS (p = 0.05 and 0.04, respectively).
  
  
  CONCLUSIONS
  Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis, and in the perception of those responsible for the children. Further studies with larger populations are needed to corroborate these results.
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Lidyanne Ilidia da Silva
authors.initials: LIDS
authors.lastname: de Paula
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Liliana Fajardo
authors.initials: LF
authors.lastname: de Oliveira
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Brysa Paiva
authors.initials: BP
authors.lastname: Cruz
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Dayana Maria
authors.initials: DM
authors.lastname: de Oliveira
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Laís Maini
authors.initials: LM
authors.lastname: Miranda
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Mauro
authors.initials: M
authors.lastname: de Moraes Ribeiro
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: Raphaela Ornellas
authors.initials: RO
authors.lastname: Duque
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil.
authors.forename: André Avarese
authors.initials: AA
authors.lastname: de Figueiredo
authors.affiliation: Division of Urology, Department of Surgery, State University of Feira de Santana (UEFS), BA, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: de Bessa
authors.affiliation: Division of Urology, Department of Surgery, Federal University of Juiz de Fora (UFJF), MG, Brazil; Division of Urology, Department of Surgery, Hospital and Maternity Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de For a (HMTJ/Suprema), MG, Brazil. Electronic address: jose.murillo@ufjf.edu.br.
authors.forename: José Murillo Bastos
authors.initials: JMB
authors.lastname: Netto
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000628:therapy*
keywords: Children; Enuresis; Incontinence; Neural stimulation; Overactive bladder; Urgency