Current state of nerve stimulation technique for lower urinary tract dysfunction in children
Mario De Gennaro1, Maria Luisa Capitanucci, Giovanni Mosiello
1Urodynamic Unit, Department of Nephrology and Urology, Children's Hospital Bambino Gesu, Rome, Italy. dege@opbg.net
The Journal of Urology
|March 23, 2011
Summary
Electrical nerve stimulation shows promise for pediatric lower urinary tract dysfunction. More research is needed to establish effective techniques and indications for these treatments in children.
Area of Science:
- Pediatric Urology
- Neurology
- Biomedical Engineering
Background:
- Electrical nerve stimulation (ENS) has been explored for decades to manage lower urinary tract dysfunction (LUTD).
- Various techniques exist, including intravesical, transcutaneous, sacral, and tibial nerve stimulation.
- Understanding their applicability, indications, and efficacy in pediatric populations is crucial.
Purpose of the Study:
- To review and analyze the techniques, devices, applicability, indications, and usefulness of electrical nerve stimulation for pediatric lower urinary tract dysfunction.
- To synthesize current knowledge on the use of ENS in children with both neurogenic and non-neurogenic LUTD.
Main Methods:
- An extensive literature search was conducted on PubMed and MEDLINE from 1990 to 2009.
- Searched for studies on various nerve stimulation methods in children with LUTD, including adult studies for comparison.
- Approximately 400 articles were identified, with 29 focusing on pediatric applications.
Main Results:
- Most studies were non-controlled due to placebo feasibility issues; few randomized trials exist.
- Sacral transcutaneous electrical nerve stimulation is favored for refractory overactive bladder in children.
- Intravesical stimulation aids sensation in neurogenic lesions; percutaneous tibial nerve stimulation is tolerated but understudied.
- Sacral neuromodulation and magnetic stimulation require further investigation in pediatric LUTD.
Conclusions:
- There is a need for more high-quality clinical trials, including those using sham devices, to validate ENS efficacy in pediatric LUTD.
- Identifying predictable variables for successful response is essential for optimizing treatment strategies.
- Further research is required to refine ENS methods and parameters for pediatric use.
Related Concept Videos
01:26The Micturition Reflex
Urination, or micturition involves the coordination of the bladder's detrusor muscle and two sphincters to ensure controlled bladder emptying.
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating urine...
The process begins with bladder filling, where the bladder wall stretches as urine accumulates. This stretching activates the urine storage reflex, mediated by the sacral spinal segments and the pontine storage center. Efferent sympathetic impulses stimulate the detrusor muscle to relax and the internal urethral sphincter to contract, facilitating urine...
01:19Urodynamic Studies: Uroflowmetry
Uroflowmetry is a non-invasive urodynamic test designed to measure various aspects of urination, including volume, flow rate, and the time to void. This test is crucial for diagnosing and assessing conditions such as bladder outlet obstruction, bladder dysfunction, incomplete bladder emptying, incontinence, and urinary tract blockages caused by benign prostatic hyperplasia (BPH) and urethral strictures.Pre-Test Instructions:Before a uroflowmetry test, patients are typically advised to drink...