Quality of life and psychological aspects in children with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation - a prospective multicenter study
Herbert Santos, Undergraduation1, Patrina Caldwell, Senior Staff Specialist2, Justine Hussong, Post doctorate3, Alexander von Gontard, PhD4, Glicia Abreu, Doctorate1, Ana Braga, Doctorate1, Maria Veiga, Doctorate1, Sana Hamilton, PhD5, Aniruddh Deshpande, PhD6, Eliakim Massuqueto, Postgraduation1, Bruna Venturini, Post graduation1, Ubirajara Barroso Jr, Chief, Head, Professor1.
1CEDIMI, Salvador, Brazil, 2The Children’s Hospital at Westmead, Sydney, Australia, 3Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany, 4Psychiatric Services Graubünden (PDGR), Outpatient Services for Child and Adolescent Psychiatry, Chur, Switzerland, 52. The Children’s Hospital at Westmead, Sydney, Australia, 6The Children’s Hospital at Westmead and John Hunter Children’s Hospital, Newcastle, Australia.
Background: The presence of LUTS in children and adolescents is associated with emotional and behavioral problems in 40.5% of cases. The treatment of children with LUTS should aim not only at resolving urinary symptoms, but also at improving physical, emotional and behavioral well-being and QoL. In view of the low risk of side effects and the efficacy of the method, parasacral transcutaneous electrical nerve stimulation (parasacral TENS) has been used in children with OAB. However, to the best of our knowledge, no study has measured the impact of this treatment on QoL and emotional/behavioral outcomes. Therefore, the objective of the present study was to assess the impact of parasacral TENS on QoL and emotional/behavioral outcomes in children with OAB. Methods: This international, multicenter, prospective cohort study involved individuals of 6 to 16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol. Results: Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Median DVSS was 11 (range 6-13.5) and 3 (range 0-7), (p<0.001), and median ICIQ-CLUTS was 12 (range 9-14) and 9 (range 5.7-12), (p<0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9-59.7) to 39 (range 29-53.15) following treatment (p=0.04). Median total SDQ score before and after treatment was 17 (range 13.5-21) and 15 (range 12-21), respectively (p=0.939). Conclusion: Parasacral TENS was associated with a significant improvement in urinary symptoms and QoL; however, there was no change in psychological symptoms, as measured using the SDQ.
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