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Neurostimulation Therapy for Pediatric Primary Enuresis: A Meta-analysis

Michael E.Chua, Nicolas Fernandez, Jessica M.Ming et al.

Urology, Volume 106, August 2017, Pages 183-187

Commentary by Guy Bogaert

In this literature review, a meta-analysis was performed from 7 nonheterogeneous randomized controlled trials that have addressed neurostimulation for nocturnal enuresis in children.  The authors conclude quite optimistic that “neurostimulation” is efficacious and safe for the treatment of nocturnal enuresis.  However, they also conclude that “further randomized clinical trials are necessary…”, already flawing their conclusion.

What exactly is neurostimulation?  Sometimes it is transcutaneous, sometimes percutaneous, some call it neuromodulation and every study has its own method, approach, currency or frequency of the stimulation.  A comparison with controls seems not sufficient, as the placebo effect may be very important.  Some studies have included placebo, but not all.  If looked upon in detail, I think that it is very difficult, if not even impossible to compare these studies.  I would therefore be very careful to draw any conclusions or accept any form of so-called “neurostimulation” as a standard treatment for children with nocturnal enuresis.  Neurostimulation for nocturnal enuresis will certainly remain experimental for a while.  

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Consensus Guidelines

Practical consensus guidelines for the management of enuresis. 
Evaluation and management of enuresis, a common condition, is not a priority in training programs for medical doctors (MDs), despite being a common condition. 

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Diagnosis and Treatment of Nocturnal Enuresis developed by the Working Group of Nocturnal Enuresis Belgium.