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Transcutaneous Electrical Nerve Stimulation of the Foot: Results of a Novel At-home, Noninvasive Treatment for Nocturnal Enuresis in Children

Matthew C. Ferroni, Rajeev Chaudhry, Bing Shen, Christopher J. Chermansky, Glenn M. Cannon, Francis X. Schneck, Michael C. Ost, Changfeng Tai, Heidi A. Stephany

Urology 2016 Oct 25. pii: S0090-4295(16)30741-5. doi: 10.1016/j.urology

Commentary by Konstantinos Kamperis

A novel approach for tens in the treatment of children with nocturnal enuresis. Can we treat enuresis by stimulating the foot?

Transcutaneous Electrical Nerve Stimulation (TENS) represents a non-invasive treatment modality for bladder overactivity but its role in the treatment of nocturnal enuresis has yet to be established. TENS is easy to apply, well tolerated, inexpensive and with only minor side effects and represents thus an attractive treatment. But is it effective in children nocturnal enuresis? The authors try to answer this question with a novel approach applying TENS on the plantar surface of the foot. The rational behind this approach according to the authors is to affect the somatic afferent nerves of the foot thus inhibiting reflex bladder activity improving capacity.

Of the twenty-five children were recruited, twenty-two completed the protocol, of them eight of them refractory to treatment with desmopressin the enuresis alarm or oxybutynin. Treatment consisted of daily stimulation for 60 min, for two weeks. Home recordings were performed for two weeks before, during and following the stimulation period.

The authors find a significant decrease in the number of wet nights during the stimulation period, which was, sustained post-treatment. Older children presented with better clinical response than the younger ones. However none of the children become completely dry.

Although TENS of the foot may seem a promising treatment option for children with enuresis in this initial report further studies are needed before implementation in the clinics. The number of participants in the study is rather low, and the design is not controlled therefore the effect on number of wet nights might not be entirely the result of TENS. Furthermore longer a follow-up will be needed to elucidate whether TENS effects is sustained. It would also be interesting to identify clinical characteristics that can be used as predictors of response to TENS.

ABSTRACT

OBJECTIVE:

To evaluate the effect of a novel at-home approach to electrical foot stimulation of peripheral tibial nerve branches on the frequency of nocturnal enuresis episodes in children.

MATERIALS AND METHODS:

Children aged 5 to 18 having 2 or more bedwetting episodes per week for at least 3 consecutive months were eligible. The study was a total of 6 weeks. Participants completed a baseline nighttime voiding diary during the first 2 weeks. This was followed by 2 weeks of foot stimulation for 60 minutes each night. During the stimulation period, and the following 2 weeks poststimulation, participants completed the nighttime voiding diary.

RESULTS:

Twenty-two patients with a mean age of 11.4 years (range 7-16) completed the study. Overall, there was a significant reduction in mean total wet nights from 9.0 ± 4.0 to 6.8 ± 4.8 during the stimulation period (P < .01) and a sustained significant reduction to 7.2 ± 5.0 wet nights during the poststimulation period (P = .02). Sixteen patients (72.7%) showed improvement of at least 1 less wet night during stimulation, demonstrating a significant improvement from a mean of 7.9 ± 3.7 to 4.8 ± 3.5 wet nights during the 2-week stimulation (P < .01) and maintained an improved mean of 5.1 ± 4.0 wet nights during the poststimulation period (P < .01). There were no adverse events experienced by any child.

CONCLUSION:

Transcutaneous foot stimulation is a well-tolerated, noninvasive, at-home treatment that may reduce the number of wet nights in children with nocturnal enuresis.