Transcutaneous neuromodulation for the urge syndrome in children: A pilot study

Purpose: Neuromodulation has been used to treat voiding dysfunction in adul ts. Due to its invasiveness it has rarely been used in children until now w ith the availability of transcutaneous neurostimulation. We evaluated clini cal effects of transcutaneous neuromodulation on detrusor overactivity in c hildren with the urge syndrome. Materials and Methods: Between May 1, 1998 and February 28, 1999, 15 girls (mean age 10.2 years) and 26 boys (mean age 10.7 years) with proved detruso r hyperactivity on videourodynamic study underwent neuromodulation. All chi ldren had been given anticholinergic therapy previously. Neurostimulation o nly was used in children in whom anticholinergics had no effect and those w ho had significant side effects. Anticholinergics were continued in childre n in whom they had a partial effect. Stimulation of 2 Hz. was applied for 2 hours every day. Surface electrodes were placed at the level of sacral roo t S3. After 1 month of trial stimulation those children who responded conti nued the treatment for 6 months, and were evaluated every 2 months. Results: Of the 41 children 15 boys and 13 girls responded after 1 month of trial therapy with an increase in bladder capacity, decrease in urgency, d ecrease in incontinence and/or better sensitivity. Of the 13 children who d id not respond 9 lacked motivation and 4 had no clinical effect despite mot ivation. After 6 months of therapy a significant increase in bladder capaci ty, decrease in voiding frequency and decrease in incontinence periods were noted. Adverse effects were not observed. One year after therapy relapse w as noted in 7 patients, leaving 21 of 41 children definitively cured. Conclusions: Although preliminary, our results indicate that transcutaneous neuromodulation can improve symptoms of detrusor overactivity, as response to stimulation was noted in 76% of our patients and 56% were cured after 1 year. This therapeutic option is attractive for children because of its no ninvasiveness and absence of adverse effects.