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Published on: September 13, 2015
Efficacy of transcutaneous posterior tibial nerve stimulation in children with functional voiding disorders
Ruslan Jafarov1, Erman Ceyhan1, Oguzhan Kahraman1
1Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Transcutaneous posterior tibial nerve stimulation (TPTNS) effectively treats functional voiding disorder in children, improving symptoms and quality of life long-term. Urine biomarkers were not useful for diagnosis or monitoring treatment response.
Area of Science:
- Pediatric Urology
- Neurology
- Medical Devices
Background:
- Functional voiding disorder (FVD) affects many children, often requiring advanced treatment options.
- Transcutaneous posterior tibial nerve stimulation (TPTNS) is a minimally invasive therapy explored for FVD.
- The diagnostic and prognostic utility of specific urine biomarkers (UBs) in FVD remains unclear.
Purpose of the Study:
- To evaluate the efficacy of TPTNS in pediatric patients with FVD unresponsive to conventional treatments.
- To assess the role of specific urine biomarkers (nerve growth factor, TGF-β1, TIMP-2) in diagnosing FVD and monitoring treatment outcomes.
Main Methods:
- A prospective randomized controlled trial involving 44 children with FVD.
- Participants were randomized to receive TPTNS, sham TPTNS, or were part of a healthy control group.
- Assessments included the Dysfunctional Voiding and Incontinence Scoring System (DVISS), voiding diaries, quality of life (QoL) scores, and UB levels before and after treatment.
Main Results:
- Both TPTNS and sham treatments significantly improved QoL and DVISS scores (day and overall).
- The TPTNS group showed significant reductions in incontinence and urgency episodes, with sustained effects at 2-year follow-up.
- No significant differences in UB levels were observed between patient groups or across treatment phases.
Conclusions:
- TPTNS is an effective treatment for children with FVD refractory to medical management, offering sustained improvements in voiding symptoms and QoL.
- UBs did not prove to be effective biomarkers for FVD diagnosis or for evaluating treatment response in this study.
- TPTNS represents a valuable therapeutic option for improving pediatric functional voiding disorder outcomes.
Aims:
To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor-beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow-up.
Methods:
A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups.
Results:
QoL scores, overall and day-time DVISS scores were significantly decreased in both sham and test groups (p < 0.05). In addition to these findings, the frequency of incontinence and urgency episodes were also significantly reduced (p < 0.05) in the TPTNS treatment group. This effect in the test group was still valid 2 years after intervention. There was no significant difference in UBs measurements between treatment and nonsymptomatic groups and between pretreatment and posttreatment measurements of test and sham groups.
Conclusions:
TPTNS is an efficient minimally invasive treatment in children with FVD who do not respond to medical treatment. TPTNS provides a significant improvement on episodes of frequency, episodes of incontinence, overall and day-time DVISS scores, and QoL scores. The effectiveness of treatment continues even at the end of the second year of intervention. UBs were not found to be predictive in terms of diagnosis and evaluating the treatment response.
