OBJECTIVES: To evaluate safety and efficacy of transcutaneous interferential (IF) electrostimulation on voiding symptoms and urodynamic variables in children with myelomeningocele (MMC)-induced refractory neurogenic detrusor overactivity. METHODS:Thirty MMC children (18 girls, 12 boys; mean age 5.6 +/- 2.7) with moderate to severe intractable incontinency, detrusor overactivity, and high maximal detrusor end-fill pressure were enrolled and then randomly allocated to treatment (IF stimulation, 20 children) and control (sham stimulation, 10 children) groups. They underwent urodynamic study (UDS) before and after IF and 6 months later, with attention to mean maximal detrusor pressure (MMDP), maximum bladder capacity (MBC), mean detrusor compliance (MDC), postvoiding residue (PVR), and detrusor sphincter dyssynergia (DSD). Daily incontinence score, voiding frequency, and enuresis were also assessed. Eighteen courses of pelvic floor IF electrostimulation for 20 minutes 3 times per week were performed with low-frequency current, duration of 250 microseconds, and repetition time of 6.6 seconds. RESULTS: Of the UDS parameters in the treatment group immediately after IF implication, MMDP, PVR, and DSD significantly improved compared with sham stimulation and pretreatment measures (P < .05). In the treatment group, 78% patients gained continence immediately after IF therapy and 60% had persistent continence for 6 months (P < .05). Immediately after IF treatment, urinary frequency and enuresis also improved (P < .05), with a statistically significant difference between the 2 groups. CONCLUSIONS: This study demonstrated that noninvasive IF therapy is effective in improving voiding symptoms including incontinence and UDS parameters of MMC children with neurogenic detrusor overactivity. The clinical beneficial implication of this modality is yet to be determined in larger studies.
RCT Entities:
OBJECTIVES: To evaluate safety and efficacy of transcutaneous interferential (IF) electrostimulation on voiding symptoms and urodynamic variables in children with myelomeningocele (MMC)-induced refractory neurogenic detrusor overactivity. METHODS: Thirty MMC children (18 girls, 12 boys; mean age 5.6 +/- 2.7) with moderate to severe intractable incontinency, detrusor overactivity, and high maximal detrusor end-fill pressure were enrolled and then randomly allocated to treatment (IF stimulation, 20 children) and control (sham stimulation, 10 children) groups. They underwent urodynamic study (UDS) before and after IF and 6 months later, with attention to mean maximal detrusor pressure (MMDP), maximum bladder capacity (MBC), mean detrusor compliance (MDC), postvoiding residue (PVR), and detrusor sphincter dyssynergia (DSD). Daily incontinence score, voiding frequency, and enuresis were also assessed. Eighteen courses of pelvic floor IF electrostimulation for 20 minutes 3 times per week were performed with low-frequency current, duration of 250 microseconds, and repetition time of 6.6 seconds. RESULTS: Of the UDS parameters in the treatment group immediately after IF implication, MMDP, PVR, and DSD significantly improved compared with sham stimulation and pretreatment measures (P < .05). In the treatment group, 78% patients gained continence immediately after IF therapy and 60% had persistent continence for 6 months (P < .05). Immediately after IF treatment, urinary frequency and enuresis also improved (P < .05), with a statistically significant difference between the 2 groups. CONCLUSIONS: This study demonstrated that noninvasive IF therapy is effective in improving voiding symptoms including incontinence and UDS parameters of MMC children with neurogenic detrusor overactivity. The clinical beneficial implication of this modality is yet to be determined in larger studies.
Authors: Yee Ian Yik; Melanie C C Clarke; Anthony G Catto-Smith; Val J Robertson; Jonathan R Sutcliffe; Janet W Chase; Susan Gibb; Timothy M Cain; David J Cook; Coral F Tudball; John M Hutson; Bridget R Southwell Journal: Pediatr Surg Int Date: 2011-03-04 Impact factor: 1.827