Effectiveness of Intra-anal Biofeedback and Electrical Stimulation in the Treatment of Children With Refractory Monosymptomatic Nocturnal Enuresis: A Comparative Randomized Controlled Trial

Abstract

PurposeTo compare the effects of intra-anal biofeedback (BF) and intra-anal electrical stimulation (ES) on pelvic floor muscles (PFMs) activity, nocturnal bladder capacity, and frequency of wet night episodes in children with refractory primary monosymptomatic nocturnal enuresis (PMNE).MethodsNinety children of both sexes aged 8–12 years with refractory PMNE participated in this study. They were randomly assigned to 3 groups of equal number: control group (CON) that underwent behavioral therapy and PFM training, and 2 study groups (BF and ES) that underwent the same program in addition to intra-anal BF training and intra-anal ES, respectively. PFMs activity was assessed using electromyography, nocturnal bladder capacity was evaluated by measuring the first morning voided volume, and a nocturnal enuresis diary was used for documenting wet night episodes before treatment and after 3 months of treatment.ResultsAfter training, all groups showed statistically significant improvements in all measured outcomes compared to their pretreatment findings. The ES group showed significantly greater improvements in all measured outcomes than the CON and BF groups.ConclusionsBoth intra-anal BF training and ES combined with behavioral therapy and PFMs training were effective in the treatment of PMNE, with intra-anal ES being superior to BF training.

The efficacy of electrical stimulation in treating children with nocturnal enuresis: A systematic review and meta‐analysis

“…On the basis of the inclusion and exclusion criteria, four RCTs [16][17][18][19] containing 171 children were involved in the article. The details of the four articles are listed in Table 1.…”

“…Nowadays, some articles have studied the efficacy of ES in treating children with MNE. The effects of ES methods have shown encouraging impacts on normalizing detrusor overactivity, enuresis frequency, and bladder capacity in certain investigations . In contrast, a recent study certificates no antienuretic effect of transcutaneous electrical nerve stimulation in children with MNE .…”

“…The effects of ES methods have shown encouraging impacts on normalizing detrusor overactivity, enuresis frequency, and bladder capacity in certain investigations. [15][16][17][18] In contrast, a recent study certificates no antienuretic effect of transcutaneous electrical nerve stimulation in children with MNE. 19 And there has been no systematic review and meta-analysis evaluating the efficacy of ES in treatment of NE in children.…”

Advances in Treatment of Nocturnal Enuresis in Children

“…The trial stated a total efficacy of three groups in the outcomes and that intra-anal ES group was superior to BF training group. But in these three outcomes, the method to assess nighttime bladder capacity with morning first urine volume is not accurate [28]. In short, there is no adequate clinical evidence to determine the therapeutic effectiveness of these NE treatments ( Table 2).…”