Role of Posterior Tibial Nerve Stimulation in the Treatment of Refractory Monosymptomatic Nocturnal Enuresis: A Pilot Study

No AccessJournal of UrologyPediatric Urology1 Apr 2013Role of Posterior Tibial Nerve Stimulation in the Treatment of Refractory Monosymptomatic Nocturnal Enuresis: A Pilot Study Ali Abdel Raheem, Yasser Farahat, Osama El-Gamal, Maged Ragab, Mohamed Radwan, Abdel Hamid El-Bahnasy, Abdel Naser El-Gamasy, and Mohamed Rasheed Ali Abdel RaheemAli Abdel Raheem , Yasser FarahatYasser Farahat , Osama El-GamalOsama El-Gamal , Maged RagabMaged Ragab , Mohamed RadwanMohamed Radwan , Abdel Hamid El-BahnasyAbdel Hamid El-Bahnasy , Abdel Naser El-GamasyAbdel Naser El-Gamasy , and Mohamed RasheedMohamed Rasheed View All Author Informationhttps://doi.org/10.1016/j.juro.2012.10.059AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We evaluated the early clinical and urodynamic results of posterior tibial nerve stimulation in patients with refractory monosymptomatic nocturnal enuresis. Materials and Methods: We randomly assigned 28 patients with refractory monosymptomatic nocturnal enuresis to 2 equal groups. Group 1 received a weekly session of posterior tibial nerve stimulation for 12 weeks and group 2 was the placebo group. Evaluation was performed in each group at baseline and after posterior tibial nerve stimulation to compare clinical and urodynamic findings. Another clinical assessment was done 3 months after the first followup. Results: The 2 groups were comparable in baseline clinical and urodynamic data. Overall, 13 patients (46.4%) had detrusor overactivity and 14 (50%) had decreased bladder capacity. After treatment 11 group 1 patients (78.6%) had a partial or full response to posterior tibial nerve stimulation but only 2 (14.3%) in group 2 had a partial response (p = 0.002). Also, the average number of wet nights in group 1 was significantly lower than at baseline (p = 0.002). All urodynamic parameters significantly improved in group 1. In contrast, the number of wet nights and urodynamic parameters did not change significantly in group 2. At 3-month followup the number of patients with a partial or full response in group 1 had decreased from 11 (78.6%) to 6 (42.9%). No change was evident in group 2. Conclusions: Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis. However, deterioration in some responders with time suggests the need for maintenance protocols. References 1 : Self esteem in children with nocturnal enuresis and urinary incontinence: improvement of self-esteem after treatment. Eur Urol1998; 33: 16. Google Scholar 2 : Behavioral therapy for primary nocturnal enuresis. J Urol2004; 171: 408. Link, Google Scholar 3 : Alarm treatment for childhood nocturnal enuresis. Scand J Urol Nephrol2002; 36: 268. Google Scholar 4 : Efficacy and safety during long-term treatment of primary monosymptomatic nocturnal enuresis with desmopressin. Acta Paediatr1999; 88: 1274. Google Scholar 5 Cendron M and Klauber G: Combination therapy in the treatment of persistent nocturnal enuresis. Br J Urol suppl., 81: 26. Google Scholar 6 : Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy. Urology2005; 66: 632. Google Scholar 7 : Alarm interventions for nocturnal enuresis in children. Cochrane Database Syst Rev2005; 2. CD002911. Google Scholar 8 : Desmopressin for nocturnal enuresis in children. Cochrane Database Syst Rev2002; 3. CD002112. Google Scholar 9 : Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev2003; 3. CD002117. Google Scholar 10 : Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int2002; 90: 302. Google Scholar 11 : Bladder dysfunction in children with refractory monosymptomatic primary nocturnal enuresis. J Urol1999; 162: 1049. Link, Google Scholar 12 : The influence of small functional bladder capacity and other predictors on the response to desmopressin in the management of monosymptomatic nocturnal enuresis. J Urol1996; 156: 651. Link, Google Scholar 13 : Daytime functional bladder capacity as a predictor of response to desmopressin in monosymptomatic nocturnal enuresis. Eur Urol1998; 33: 25. Crossref, Medline, Google Scholar 14 : Micturition habits and bladder capacities in normal children and in patients with desmopressin-resistant enuresis. Scand J Urol Nephrol Suppl1995; 173: 49. Google Scholar 15 : Tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol2001; 166: 914. Link, Google Scholar 16 : Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol2001; 165: 1193. Link, Google Scholar 17 : Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: a pilot study. J Urol2002; 168: 2605. Link, Google Scholar 18 : Long-term efficacy of percutaneous tibial nerve stimulation for different types of lower urinary tract dysfunction in children. J Urol2009; 182: 2056. Link, Google Scholar 19 : Percutaneous tibial nerve neuromodulation is well tolerated in children and effective for treating refractory vesical dysfunction. J Urol2004; 171: 1911. Google Scholar 20 : The standardization of terminology of lower urinary tract function in children and adolescents. J Urol2006; 176: 314. Link, Google Scholar 21 : Afferent nerve stimulation for pelvic floor dysfunction. Eur Urol1999; 35: 16. abstract 62. Google Scholar 22 : Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT Trial. J Urol2010; 183: 1438. Link, Google Scholar 23 : Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the Overactive Bladder Innovative Therapy Trial. J Urol2009; 182: 1055. Link, Google Scholar 24 : Primary enuresis: a urodynamic evaluation. Br J Urol1998; 81: 50. Google Scholar 25 : Bladder reservoir function in children with monosymptomatic nocturnal enuresis and healthy controls. J Urol2006; 176: 759. Link, Google Scholar 26 : Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic based study. Urology2000; 56: 766. Google Scholar 27 : Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn2003; 22: 227. Google Scholar 28 : Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary?. BJU Int2006; 97: 547. Google Scholar Urology Department, Tanta University Hospital, Tanta, El Gharbia, Egypt© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byRitchey M (2013) This Month in Pediatric UrologyJournal of Urology, VOL. 189, NO. 4, (1183-1184), Online publication date: 1-Apr-2013. Volume 189Issue 4April 2013Page: 1514-1518 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordstreatment outcomenocturnal enuresisurinary bladderMetricsAuthor Information Ali Abdel Raheem More articles by this author Yasser Farahat More articles by this author Osama El-Gamal More articles by this author Maged Ragab More articles by this author Mohamed Radwan More articles by this author Abdel Hamid El-Bahnasy More articles by this author Abdel Naser El-Gamasy More articles by this author Mohamed Rasheed More articles by this author Expand All Advertisement PDF downloadLoading ...