Monday, August 6, 2012

PERCUTANEOUS TIBIAL NERVE NEUROMODULATION IS WELL TOLERATED IN CHILDREN AND EFFECTIVE FOR TREATING REFRACTORY VESICAL DYSFUNCTION


ABSTRACT

Purpose: We evaluated pain tolerability and the preliminary results of percutaneous tibial nerve stimulation (PTNS) in children with unresponsive lower urinary tract symptoms (LUTS).

Materials and Methods: A total of 23 children 4 to 17 years old with LUTS refractory to conventional treatment underwent PTNS at 12, 30-minute weekly sessions. Ten patients had idiopathic overactive bladder, 7 were in nonneurogenic urinary retention and 6 had neuropathic bladder. Ten children were carefully evaluated for pain during needle insertion and electrical stimulation using certain scoring systems, namely the faces pain rating scale, Children’s Hospital of Eastern Ontario pain scale, visual analogue scale and Questionario Italiano del Dolore.
Evaluation was done at the first, sixth and last sessions. An anxiety-depression test was administered. All 23 children underwent clinical and urodynamic evaluation before and after treatment.

Results: All except 1 patient completed treatment. An anxious-depressive trait was found in 7 of 10 children/parents on anxiety-depression testing. Regarding pain, the faces pain rating scale never showed the severe pain face, the Children’s Hospital of Eastern Ontario scale showed signs of pain at the beginning of each stimulation but not at the end, and the visual analog scale generally showed a low score with a further decrease during the first (p _ 0.05), sixth (p _ 0.03) and twelfth (p _ 0.02) sessions. The Questionario Italiano del Dolore score was significantly related to the affective component of pain (p _ 0.002) and it decreased between the first and last sessions. The 10 children with overactive bladder had symptom improvement in 80%, incontinence was cured in 5 of 9 and urodynamics showed normalization of cystometric bladder capacity in 62.5% with no more unstable contractions in those who became continent. Symptoms improved in 71% of the children in urinary retention. One of 3 and 4 of 7 patients had incontinence and post-void residual urine cured, respectively. Urodynamics showed an improved detrusor pressure at maximum flow (p _ 0.009) and flow rate (p _ 0.005). Symptoms and urodynamics did not significantly change in the neuropathic bladder group.

Conclusions: PTNS is safe, minimally painful and feasible in children. It seems helpful for treating refractive nonneurogenic LUTS.

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