Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Lower Urinary Dysfunction. A Study of the electric current intensity.
Ubirajara Barroso Junior, Doctor, PhD, Maria F. Silva, Undergraduate, Maria L. Veiga, Doctor, PhD, Glicia Abreu, Doctor, Maria T. Calasans, Doctor, PhD.
Bahiana School of Medicine, Salvador, Brazil.
BACKGROUND: Parasacral transcutaneous electrical nerve stimulation (TENS) is an effective treatment for children with lower urinary tract dysfunction (LUTD). The nerve activation is influenced by many factors including the electric current intensity (ECI). This study aims to evaluate whether there is a relationship between the ECI and Parasacral TENS efficacy, as well as to analyze the variation of the TENS ECI in each patient. To our knowledge this is the first study that evaluate the influence of the ECI in the LUTS outcome. METHODS: Retrospective analysis of a prospectively collected database of patients with LUTD, aged between 5 and 17 years, who completed twenty sessions of parasacral TENS performed three times a week was carried out. In each session the ECI was applied until the tolerability threshold and below the motor threshold. A biphasic electric current of frequency equal to 10 Hz and pulse width of 250 or 700 Ás was applied through two electrodes, positioned bilaterally in the parasacral region. Pre- and post-treatment Dysfunctional Voiding Scoring System (DVSS) score and post-treatment visual analogue scale (VAS) were used for outcome assessment. The patients were divided into two groups: with and without complete resolution of the symptoms. RESULTS: We studied 76 children with mean age of 8.39 ▒ 3.03 years, most were female (63.2%). LUTD resolved completely in 55% of the cases. There was no difference between the ECI in both groups, cured and uncured groups (14.25, IQR=12 - 18.12 X 14.25, IQR= 12 - 16.25; p=0.75). There was a weak association between the change in the DVSS score before and after treatment and the ECI (r2= 0.29; p= 0.25). The median of the maximum and minimum ECI was 20.5 (16 - 25) and 9 (7- 11), respectively. The median of ECI range was 11.5 (7 - 15.75). There was no association of maximum ECI and age and gender (p=0,79; p=0,30, respectively). CONCLUSIONS: Our study shows that the ECI is not associated with LUTD resolution. Age and gender have no relationship with ECI. We saw a high range of ECI per patient.
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