Parasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: A Randomized Clinical Trial.

ABSTRACT

PURPOSE: Parasacral transcutaneous electrical nerve stimulation has been used to manage lower urinary tract symptoms refractory to standard urotherapy. Nevertheless, its actual effectiveness in treatment of bladder and bowel dysfunction remains to be established. We sought to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of children with bladder and bowel dysfunction. MATERIALS AND METHODS: This was a randomized clinical trial conducted with children and adolescents of 5-17 years of age diagnosed with bladder and bowel dysfunction. Patients with neurological or anatomical abnormalities of urinary or digestive tracts, those unable to attend treatment sessions 3 times a week, individuals with diabetes mellitus or diabetes insipidus and those using anticholinergic drugs or laxatives were excluded from the study. The sample was divided into 2 groups a control group submitted to standard urotherapy plus sham electrotherapy applied to the scapular region and a treatment group submitted to urotherapy plus parasacral transcutaneous electrical nerve stimulation. All the patients were submitted to 3, 20-minute electrotherapy (parasacral transcutaneous electrical nerve stimulation or sham) sessions/week for a total of 20 sessions. RESULTS: Forty patients were evaluated, 20 in the control group and 20 in the treatment group. Mean age (±standard deviation) was 8.4±2.8 years and 52.5% were male. In 15 patients (37.5%), rectal diameter was ≥3 cm. Lower urinary tract symptoms improved in both groups following treatment, with no statistically significant differences in Dysfunctional Voiding Scoring System score, lower urinary tract symptoms or uroflowmetry patterns between the groups. Intragroup evaluation showed a significant improvement in enuresis in the treatment group. There was a significant improvement in functional constipation post-intervention in treatment group compared to control group (70% vs 20%, p=0.004). CONCLUSIONS: Parasacral transcutaneous electrical nerve stimulation is effective for treatment of bladder and bowel dysfunction in children and adolescents, particularly insofar as functional constipation is concerned.