Longer-Term Evaluation of Parasacral Transcutaneous Electrical Nerve Stimulation in the Treatment of Bladder and Bowel Dysfunction in Children and Adolescents.
Ícaro Antônio Ribeiro Barreto, Student, Glicia de Abreu Tourinho, PhD, Maria Luiza Veiga da Fonseca, PhD, Ana Aparecida Nascimento Martinelli Braga, PhD, Ubirajara de Oliveira Barreto, Jr., PhD.
Bahiana School of Medicine, Salvador, Brazil.
BACKGROUND: Parasacral transcutaneous electrical nerve stimulation (TENS) has been used in the treatment of bladder and bowel dysfunction (BBD) in children and adolescents. Although its short-term efficacy has already been demonstrated, to our knowledge there is no study that evaluates the long-term outcome. The objective of this study is to evaluate the long-term efficacy of parassacral TENS in the treatment of children and adolescents with BBD.
METHODS: We evaluated prospectively a cohort of patients who participated of a randomized clinical trial (Parasacral TENS versus Sham) recently published by our group (J Urol, 2020). Children and adolescents aged 05 to 17 years diagnosed with BBD were included. The guardians were interviewed by phone. The Dysfunctional Voiding Symptom Score (DVSS) and the Visual Analog Scale (VAS) were used to evaluate the lower urinary tract symptoms (LUTS). For constipation evaluation, the Rome IV criteria, the Constipation Score adapted for children and adolescents, the Bristol Stool Scale and the Wong Baker Faces Scale were used.
RESULTS: Contact was established with 28 children and adolescents' caregivers (15 in the sham group and 13 in the test group). The median age was 8 years (6-9) and 50% of the patients were female. The median follow-up of patients was 29 months (24-36). We observed that constipation and LUTS worsen in the parassacral TENS group when compared with the short-term evaluation (Rome IV (p=0.04), constipation score (p=0.004) and DVSS (p=0.009)). No changes were seen regarding the constipation and LUTS in the sham group.
CONCLUSIONS: Although we have demonstrated in a previous study that parassacral TENS was effective for BBD in a short-term evaluation, the current data show impairment of constipation and LUTS with time. These results point out that patients with BBD should be followed closely after treatment with TENS and should be treated if recurrence of the symptoms.
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