Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory...

Area of Science:

• Pediatric Urology
• Pelvic Floor Rehabilitation
• Neuromodulation

Background:

• Refractory primary monosymptomatic nocturnal enuresis (PMNE) poses a significant challenge in pediatric urology.
• Current treatments often involve behavioral therapy and pelvic floor muscle (PFM) training, but effectiveness can be limited in refractory cases.
• Investigating novel therapeutic modalities is crucial for improving outcomes in children with PMNE.

Purpose of the Study:

• To compare the efficacy of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) in treating refractory primary monosymptomatic nocturnal enuresis (PMNE).
• To assess the impact of BF and ES on pelvic floor muscle (PFM) activity, nocturnal bladder capacity, and the frequency of wet night episodes.
• To evaluate these interventions in conjunction with standard behavioral therapy and PFM training.

Main Methods:

• A randomized controlled trial involving 90 children (aged 8-12 years) with refractory PMNE.
• Participants were assigned to three groups: control (behavioral therapy + PFM training), BF group (behavioral therapy + PFM training + intra-anal BF), and ES group (behavioral therapy + PFM training + intra-anal ES).
• Outcomes including PFM activity (electromyography), nocturnal bladder capacity (first morning voided volume), and enuresis frequency (diary) were measured before and after 3 months of treatment.

Main Results:

• All treatment groups demonstrated statistically significant improvements in PFM activity, bladder capacity, and reduced enuresis frequency compared to baseline.
• The intra-anal electrical stimulation (ES) group exhibited significantly greater improvements across all measured parameters compared to both the control (CON) and biofeedback (BF) groups.
• Both BF and ES, when added to standard therapy, proved effective, but ES demonstrated superior outcomes.

Conclusions:

• Intra-anal biofeedback (BF) and electrical stimulation (ES) are effective adjuncts to behavioral therapy and PFM training for treating refractory primary monosymptomatic nocturnal enuresis (PMNE).
• Intra-anal electrical stimulation (ES) was found to be more effective than intra-anal biofeedback (BF) in improving PFM activity, nocturnal bladder capacity, and reducing wet nights.
• These findings suggest ES as a promising therapeutic option for children with refractory PMNE.