Malm-Buatsi E et al. (2007) Efficacy of transcutaneous electrical nerve stimulation in children with overactive bladder refractory to pharmacotherapy. Urology 70: 980–983

Electrical neurostimulation has demonstrated good results when used as a primary therapy in studies of children with overactive bladder (OAB); however, this treatment modality has not been specifically evaluated in children with OAB who do not show symptom improvement with behavioral and pharmacological therapy. Malm-Buatsi and colleagues retrospectively reviewed the medical charts of children with pharmacotherapy-refractory OAB who were treated with transcutaneous electrical nerve stimulation (TENS).

The study included data from 18 children (mean age 9.4 years, range 5–14 years; 13 girls), of whom 15 had incontinence (mean 3.2 ± 2.1 daytime accidents) and 3 had only increased urgency or frequency. Ten patients continued to use anticholinergic drugs throughout the study. TENS was performed for 20 min twice daily for a mean of 8 ± 7 months, and children were followed up for a mean duration of 13 ± 9 months from the initiation of treatment.

Of the 15 patients with incontinence, 2 (13%) became dry (fully continent), 9 had significantly improved continence (at least 50% reduction in daytime accidents) and 4 (27%) had no improvement by the last follow-up visit. Of 12 patients with marked urinary frequency, 8 (67%) reported subjective improvement, and 1 (14%) of 7 patients with nocturnal enuresis became dry.

Despite the limitations of this study, the authors concluded that TENS was well tolerated and resulted in an improvement rate of 73% after 13 months' follow-up. Randomized, controlled trials are warranted to confirm these findings and identify factors predictive of a good response to this treatment.