Neurostimulation Therapy for Pediatric Primary Enuresis : a Meta-Analysis

Abstract Objectives To assess the efficacy and safety of neurostimulation compared to control groups in the treatment of pediatric primary enuresis (PPE) by performing meta-analysis of randomized controlled trials (RCTs) Methods A systematic literature search with no language restriction was done in August 2016. RCTs were identified and evaluated according to the Cochrane Collaboration risk of bias assessment recommendations. The number of patients with post-treatment: partial response /PR (50%-89%), complete response /CR (≥90%) and full response/ FR (100%) responses were extracted for relative risk (RR) and 95% confidence interval (CI). Effect estimates were pooled using the Mantel-Haenszel method. PROSPERO registry (CRD42016043502) Results A total of 292 subjects from 7 non-heterogeneous RCTs were included for meta-analysis. Pooled effect estimate of subjects with≥50% post-treatment wet-night reduction (PR, CR & FR) showed a significantly better outcome after neurostimulation compared to controls (RR=2.20, 95%CI 1.66, 2.90). While patients with ≥90% post-treatment wet-night reduction (CR & FR), showed a significantly better outcome in the neurostimulation groups (RR=2.79, 95%CI 1.54, 5.06). Furthermore, a significant mean difference in wet-night reduction per week was noted between treatment groups in favor of neurostimulation treatment (MD-1.95, 95%CI -2.84, -1.07). No serious adverse effects were noted related to neurostimulation therapy. Conclusion Current evidence suggests that neurostimulation therapy is efficacious and safe for the treatment of PPE. Head-to-head randomized clinical trials are needed to further assess relative efficacy amongst variable treatment protocols.