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Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in
Maria Luisa Capitanucci1, Daniela Camanni, Francesca Demelas
1Department of Nephrology-Urology, Children's Hospital Bambino Gesù, Rome, Italy. capitanucci@opbg.net
Insights
Percutaneous tibial nerve stimulation effectively treats pediatric lower urinary tract dysfunction, particularly nonneurogenic types like dysfunctional voiding. Results show significant improvement and cure rates, supporting its use in pediatric urology.
Area of Science:
- Pediatric Urology
- Neuromodulation
- Lower Urinary Tract Dysfunction
Background:
- Pediatric lower urinary tract dysfunction (LUTD) encompasses various conditions affecting bladder control.
- Refractory cases often require advanced therapeutic options beyond conventional treatments.
Purpose of the Study:
- To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) in children with different types of refractory LUTD.
- To compare PTNS outcomes across various pediatric LUTD diagnoses.
Main Methods:
- A cohort of 39 children with refractory LUTD (idiopathic overactive bladder, dysfunctional voiding, underactive bladder, etc.) received 12 weeks of weekly PTNS.
- Efficacy was assessed using bladder diaries, uroflowmetry, and urinalysis pre- and post-treatment.
- Improved patients were followed for up to two years to assess long-term outcomes.
Main Results:
- PTNS demonstrated significantly higher efficacy in nonneurogenic LUTD (78% improvement) compared to neurogenic cases (14%).
- Dysfunctional voiding and overactive bladder showed high improvement rates (100% and 92%, respectively), with notable cure rates (71% and 41% at 2 years for dysfunctional voiding and overactive bladder, respectively).
- Underactive bladder types showed lower response rates, with 18-50% being unresponsive.
Conclusions:
- Percutaneous tibial nerve stimulation is a reliable and effective treatment for nonneurogenic, refractory pediatric LUTD.
- Efficacy appears greater in dysfunctional voiding compared to overactive bladder.
- PTNS should be considered a valuable tool in pediatric urology for managing functional incontinence.
Purpose:
We evaluated the efficacy of percutaneous tibial nerve stimulation for different types of pediatric lower urinary tract dysfunction.
Materials And Methods:
A total of 14 children with idiopathic overactive bladder, 14 with dysfunctional voiding, 5 with underactive bladder, 4 with underactive valve bladder and 7 with neurogenic bladder resistant to conventional therapy underwent percutaneous tibial nerve stimulation weekly for 12 weeks. The stimulation effect was evaluated by comparing bladder diary, flowmetry and urinalysis before and after treatment. Improved patients were followed by bladder diary and urinalysis. Followup data at 1 and 2 years were compared with those obtained after stimulation. Data were analyzed using Fisher's exact test.
Results:
Symptom improvement was significantly greater in nonneurogenic than in neurogenic cases (78% vs 14%, p <0.002). Of patients 18% with underactive bladder and 50% with underactive valve bladder were unresponsive. Of 14 overactive bladder cases 12 and all 14 of dysfunctional voiding were improved (p not significant). Of improved patients 5 of 12 with overactive bladder and 12 of 14 with dysfunctional voiding were cured (p <0.01). On uroflowmetry voided volume and post-void residual urine became normal in a greater number of dysfunctional voiding than overactive bladder cases (57% vs 20% and 57% vs 25%, each p not significant). At 1 year of followup the cure rate was greater in dysfunctional voiding than in overactive bladder cases (71% vs 41%) and it remained the same at the 2-year evaluation. Chronic stimulation was necessary to maintain results in 29% of dysfunctional voiding and 50% of overactive bladder cases.
Conclusions:
Percutaneous tibial nerve stimulation is reliable and effective for nonneurogenic, refractory lower urinary tract dysfunction in children. Efficacy seems better in dysfunctional voiding than in overactive bladder cases. There is evidence that percutaneous tibial nerve stimulation should be part of the pediatric urology armamentarium when treating functional incontinence.
