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Intravesical electrical stimulation in the treatment of micturition dysfunction in children
Gunilla Gladh1, Sven Mattsson, Sivert Lindström
1Department of Molecular and Clinical Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping, Sweden. gunilla.gladh@lio.se
Insights
Intravesical electrical stimulation (IVES) shows promise for treating underactive detrusor in children, offering an alternative to clean intermittent catheterization (CIC). Many patients achieved normalized voiding and reduced infections, suggesting IVES is an effective therapeutic option.
Area of Science:
- Pediatric Urology
- Neurology
- Biomedical Engineering
Background:
- Underactive detrusor in children can lead to significant voiding dysfunction and urinary tract issues.
- Clean intermittent catheterization (CIC) is a common management strategy, but alternatives are sought.
- Intravesical electrical stimulation (IVES) presents a potential non-invasive therapeutic option.
Purpose of the Study:
- To evaluate the efficacy of intravesical electrical stimulation (IVES) for treating pediatric underactive detrusor.
- To assess IVES as an alternative to clean intermittent catheterization (CIC).
Main Methods:
- An open prospective study involving 44 children with idiopathic or neurogenic underactive detrusor.
- IVES delivered via a bladder catheter electrode and suprapubic anode, with continuous stimulation.
- Treatment outcomes monitored via voiding diaries, bladder sensation, urinary flow, residual volume, and infection rates.
Main Results:
- 39 out of 44 children completed the IVES treatment.
- Significant long-term voiding normalization achieved in 83% of idiopathic cases and 40% of neurogenic cases.
- 11 out of 15 children on CIC discontinued catheterization after IVES; urinary tract infections and incontinence decreased significantly (P < 0.01).
Conclusions:
- Intravesical electrical stimulation (IVES) is a promising method for treating underactive detrusor in children.
- IVES can lead to normalized voiding and reduced complications, improving quality of life.
- The study supports IVES as a viable alternative to CIC for select pediatric patients.
Aims:
To evaluate the results of intravesical electrical stimulation (IVES) in an open prospective study to treat underactive detrusor in children. The treatment was offered as an alternative to clean intermittent catheterization (CIC).
Methods:
Forty-four children were included, 21 girls and 3 boys (6-16 years, md 10) with idiopathic, 9 girls and 11 boys (4-18 years; md 13) with neurogenic underactive detrusor. IVES was given by a catheter electrode in the bladder (cathode) with the anode attached to the suprapubic abdominal skin. Continuous stimulation at 20 or 25 Hz was delivered by battery powered stimulators giving unipolar square-wave pulses (0,2 or 0,7 ms). Stimulation intensity was adjusted individually according to the acceptance of the child (12-64 mA). IVES was initially given at the clinic but 18 children had additional treatment at home. Effect of treatment was monitored by micturiton/incontinence diary, reports of bladder sensation, recordings of urinary flow, residual volume and frequency of urinary tract infections.
Results:
The IVES-treatment was completed by 39/44 children. Long term normalization of the voiding (md 2,5 years follow up) was obtained for 20/24 children with idiopathic problems (83%) and 8/20 with neurogenic problems (40%). Another four had much improved bladder function. The neurogenic group required more stimulation sessions than the idiopathic group. Of those on CIC, 11/15 who completed IVES could discontinue the catheterization. The frequency of urinary tract infections and incontinence decreased significantly (P < 0.01).
Conclusions:
It is concluded that IVES is a promising method to treat the underactive detrusor in children.