INITIAL EXPERIENCE WITH HOME THERAPEUTIC ELECTRICAL-STIMULATION FOR CONTINENCE IN THE MYELOMENINGOCELE POPULATION

Purpose: In an attempt to enhance bladder and bowel continence 29 pati ents underwent Icing duration, low intensity transcutaneous therapeuti c electrical stimulation. This technology has previously been shown to be effective for inducing regenerative hypertrophy of disuse atrophie d skeletal muscle, and it has been associated with improved continence in the myelomeningocele population. Our objectives were to enhance ur inary and fecal continence, and evaluate the mechanisms by which thera peutic electrical stimulation influences continence; Materials and Met hods: A total of 29 children with lumbar or sacral myelomeningocele un derwent therapeutic electrical stimulation at home during sleep using a commercially available stimulator with a safety sensing circuit and 2 sets of electrodes placed on the skin at bedtime. Left and right sid e electrode placement was alternated on 6 of 7 consecutive nights, In 9 boys and 2 girls with more than 9 months of followup initial and sub sequent cystometrography, urethral pressure profile, electromyography, voiding cystourethrography and renal ultrasound studies were evaluate d, Results: In the II children there was no radiographic evidence of u rinary tract or musculoskeletal deterioration during treatment. Mean a ctual bladder capacity increased from 133 to 198 ml. (p < 0.05). Mean bladder capacity, as a percent of maximum predicted bladder capacity f or a normal age matched child without; myelomeningocele, also signific antly increased from 59 before to 76%; after 9 months of therapeutic e lectrical stimulation (p < 0.05). No significant change was noted in u rethral pressure profile. A subjective improvement in the sensation of pelvic fullness was also observed. Conclusions: When administered at home by parents while the child sleeps, therapeutic electrical stimula tion is safe for bladder and bowel continence in the myelomeningocele population. It seems to increase significantly bladder capacity, does not appear to change urethral pressure profile and results in a subjec tively improved sensation of pelvic fullness, enhancing urinary and fe cal continence, The most beneficial effect of therapeutic electrical s timulation seems to be on the bladder wall and less so on the striated pelvic floor musculature with subjective enhancement of pelvic fullne ss also contributing positively.