Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Objective: This study aimed to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation (p-TENS) in children with detrusor overactivity (DO) who were subjected to standard medical treatment, urotherapy, and/or biofeedback. Materials and Methods: Thirty-two children (female: 17, male: 15) underwent p-TENS because of refractory lower urinary tract dysfunction symptoms between 2017 and 2019. Children with neurogenic bladder (n=7) and dysfunctional voiding (n=13) were excluded. The data of 12 children diagnosed with DO after the urodynamic study (boys: 8, girls: 4), were evaluated for treatment response 6 months after the last session. p-TENS was performed using S2-3 dermatome 2 days a week for 3 months. Each session lasted 20 min with a frequency of 10 Hz and generated a pulse of 250 [micro]s. Results: The median age of 12 children was 11 years (interquartile range 25-75, range: 9.5-12.5). Incontinence is the main complaint. Significant improvement in uroflow parameters was detected in all children. Urgency, urge incontinence (p=0.016), and constipation (p=0.031) rates were significantly decreased. Voiding dynamics revealed improved voiding patterns (pre/post tower shaped pattern; n=7 vs. n=2), and incontinence was completely resolved in nine children (75%). Conclusion: P-TENS has emerged as a therapeutic alternative in children with DO refractory to standard treatment protocol and medication. Keywords: lower urinary tract dysfunction, refractory overactivity, TENS, urinary incontinence