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Maximal electrical stimulation in children with unstable bladder and nocturnal enuresis and/or daytime incontinence:
Insights
Maximal electrical stimulation (MES) effectively treats childhood unstable bladder, nocturnal enuresis, and daytime incontinence. This therapy significantly improved symptoms and urodynamic parameters in girls, offering a promising treatment option.
Area of Science:
- Pediatric Urology
- Neurology
- Physiology
Background:
- Idiopathic detrusor instability is a common cause of bladder dysfunction in children.
- Nocturnal enuresis and daytime incontinence significantly impact a child's quality of life.
- Current treatment options for pediatric unstable bladder may have limitations.
Purpose of the Study:
- To evaluate the clinical and urodynamic efficacy of anal maximal electrical stimulation (MES) in children.
- To assess MES for treating unstable bladder, nocturnal enuresis, and daytime incontinence.
- To compare MES outcomes with a control group using a non-stimulated anal plug.
Main Methods:
- Seventy-three girls (5-17 years) with diagnosed idiopathic detrusor instability received 1-2 months of anal MES.
- A control group of 21 girls (6-14 years) used a non-powered anal plug for 1 month.
- Clinical outcomes (cure/improvement rates) and urodynamic parameters were assessed post-treatment.
Main Results:
- 75% of girls treated with MES showed significant improvement or cure of symptoms.
- MES significantly reduced monthly nocturnal enuresis episodes (from 14 to 6.5) and daytime incontinence (from 3 to 0).
- Urodynamic studies revealed increased bladder capacity, compliance, and desire to void, with reduced uninhibited contractions post-MES.
Conclusions:
- Anal MES is an effective treatment for nocturnal enuresis and daytime incontinence in children with unstable bladders.
- The treatment demonstrates significant improvements in both clinical symptoms and objective urodynamic measures.
- Recurrence rates were manageable, supporting MES as a recommended therapeutic option.
Abstract:
The aim of this study was to investigate clinical and urodynamic effects of anal MES in children with unstable bladder and micturition problems (nocturnal enuresis and/or daytime incontinence). Seventy-three girls, aged 5 to 17 years, mean age 9.7 years, with cystometrically proved idiopathic detrusor instability and nocturnal enuresis and/or daytime incontinence, were treated by maximal electrical stimulation (MES) for 1 to 2 months. Twenty-one girls, aged 6 to 14 years, mean age 9.3 years, with unstable bladder and micturition problems used only the anal plug without a battery for 1 month and served as the control group. Four and a half months (1-36 months) after the end of treatment, 75% of the stimulated patients were cured or improved by 50% or more. In the control group, 86% of the girls remained unchanged (P < 0.01). One month after the completion of anal MES the average number of monthly nocturnal enuretic episodes fell from 14 to 6.5 (P < 0.001) and the number of daytime incontinence episodes diminished from 3 to 0 (P < 0.001). On an average of 14.5 months after the end of anal MES, enuresis recurred in 20% of cases. Post-MES cystometry showed intensified first desire to void (P < 0.05), as well as an increase in maximum cystometric capacity (P < 0.0001), bladder compliance (P < 0.0001), and volume of the first detrusor contraction (P < 0.01). A statistically significant decline in the number of uninhibited contractions was also noticed (P < 0.001). In the control group, the anal plug did not produce any significant cystometrical changes. Anal MES can be recommended as an effective method for treating nocturnal enuresis and/or daytime incontinence and unstable bladder in children.