BACKGROUND: There is a significant epidemiological relationship between psychological problems and higher prevalence of Lower Urinary Tract Symptoms (LUTS) in patients with overactive bladder (OAB). In this case, children more affected by psychological problems and impaired quality of life (QoL) may also be related to a higher failure rate in the treatment of OAB with parasacral transcutaneous electrical nerve stimulation (TENS). The aim of this study is to assess whether the QoL and psychological alterations, evaluated by the Pediatric Incontinence Questionnaire (PinQ) and the Strength and Difficulties Questionnaire (SDQ) scores, respectively, are prognostic predictors of treatment failure for OAB with parasacral TENS.
METHODS: This is an international, multicenter, ambispective cohort study involving children between 5 and 16 years of age under parasacral TENS with a diagnosis of OAB. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires used were Dysfunctional Urination Symptom Score (DVSS) to assess LUTS intensity and the PinQ and SDQ scores to evaluate the QoL and psychological alteration, respectively. Treatment failure was assessed by using the ∆ DVSS percentile; patients with an improvement equal to or above 50% were considered cured. PinQ scores above 60 and SDQ scores above 16 were considered abnormal.
RESULTS: Seventy-seven patients were included in the study, 47 from the South American center, 26 in the Oceania center, and 9 from the European center, with a mean age of 8.9±2.8, and 44 (57.1%) were female. In the pre-treatment period, 21 (27.3%) patients had an altered PinQ score, and 39 (50.6%) had an altered SDQ score. In the analysis of the association between the improvement rate measured by ∆ DVSS and the pre-treatment PinQ value, there was no statistically significant association, p=0.773. In evaluating the accuracy of pre-treatment PinQ regarding the response to parasacral TENS, the ROC curve had an area under the curve of 0.555 with a p-value of 0.404. Furthermore, in the analysis of the association between the improvement rate measured by ∆ DVSS and the pre-treatment SDQ value, there was no association, p=0.383. Finally, in evaluating the accuracy of pre-treatment SDQ regarding the response to parasacral TENS treatment, the ROC curve had an area under the curve of 0.609 with a p-value of 0.133.
CONCLUSIONS: Clinically significant emotional and behavioral issues, measured by SDQ, and QoL, measured by PinQ, cannot accurately predict failure after parasacral TENS for OAB in children.
