Although preliminary, our results indicate that transcutaneous neuromodulation can improve symptoms of detrusor overactivity, as response to stimulation was noted in 76% of our patients and 56% were cured after 1 year. This therapeutic option is attractive for children because of its noninvasiveness and absence of adverse effects.
Percutaneous electrical nerve stimulation has a significant effect on voiding frequency, the uroflowmetry curve and bladder capacity in children with nonneurogenic bladder sphincter dysfunction
Objective To analyse experience in treating young children (4±5 years old) with urodynamically con®rmed voiding dysfunction, using a noninvasive training programme. Patients and methods Between January 1996 and October 1997, 20 children (all <5 years old, mean age 4.45 years, 18 girls and two boys, mean ages 4.44 and 4.5 years, respectively) with voiding dysfunction were treated. Three children showed ®lling phase dysfunction alone (bladder instability), six emptying phase dysfunction alone (dysfunctional voiding) and 11 showed both ®lling and emptying phase dysfunction. Sixteen children had incontinence problems (three diurnal, two nocturnal and 11 diurnal and nocturnal). Eight children had a history of recurrent urinary tract infections and 12 girls had vaginal irritation. Four children were referred for perineal pain caused by spasms of the pelvic¯oor. Eight children had encopresis based on chronic obstipation. Therapy consisted of keeping a voiding and drinking chart, instructions on proper toilet posture, daily rules for application at home, and if possible relaxation biofeedback of the pelvic-¯oor muscles. Therapy was considered successful if incontinence and other urological symptoms resolved. The treatment of encopresis is also discussed. Results Of the 20 children, 13 had a good result; they all became dry during the day and night, and encopresis resolved. Six children had moderate success; in one, nocturnal incontinence persisted, and in two diurnal and nocturnal incontinence continued. In two children encopresis persisted and in one the faecal incontinence ameliorated. In one child the therapy was prematurely interrupted because of lack of motivation. Conclusion This experience suggests that a noninvasive training programme is applicable in very young children with symptoms of dysfunctional elimination of urine and faeces.
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