title: Slow-transit constipation with concurrent upper gastrointestinal dysmotility and its response to transcutaneous electrical stimulation Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial. Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: a randomized controlled trial. Parasacral transcutaneous electrical neural stimulation (PTENS) once a week for the treatment of overactive bladder in children: A randomized controlled trial. Treatment with propiverine in children suffering from nonneurogenic overactive bladder and urinary incontinence: results of a randomized placebo-controlled phase 3 clinical trial. Daily transabdominal electrical stimulation at home increased defecation in children with slow-transit constipation: a pilot study. Percutaneous electrical nerve stimulation in children with therapy resistant nonneuropathic bladder sphincter dysfunction: a pilot study. Micturition habits and incontinence at age 17--reinvestigation ofa cohort studied at age 7. Solifenacin in Children and Adolescents with Overactive Bladder: Results of a Phase 3 Randomised Clinical Trial. The natural history of urinary symptoms during adolescence. A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence. Transcutaneous parasacral electrical stimulation vs oxybutynin for the treatment of overactive bladder in children: a randomized clinical trial.
abstract: Purpose Transcutaneous electrical stimulation ( TES ) speeds up colonic transit in children with slow-transit constipation ( STC ) . This study examined if concurrent upper gastrointestinal dysmotility ( UGD ) affected response to TES . Methods  Radio-nuclear transit studies ( NTS ) were performed before and after TES treatment of STC as part of a larger r and omised controlled trial . UGD was defined as delayed gastric emptying and /or slow small bowel transit . Improvement was defined as increase of ≥1 Geometric Centre ( median radiotracer position at each time [ small bowel = 1 , toilet = 6 ] ) . Results Forty-six subjects completed the trial , 34 had NTS after stimulation ( 21 M , 8–17 years , mean 11.3 years ; symptoms > 9 years ) . Active stimulation increased transit in > 50 % versus only 25 % with sham ( p = 0.04 ) . Seventeen children also had UGD  . In children with STC and either normal upper GI motility ( NUGM ) and UGD , NTS improved slightly after 1 month ( 57 vs. 60 % ; p = 0.9 ) and more after 2 months ( 88 vs. 40 % ; p = 0.07 ) . However , mean transit rate significantly increased with NUGM , but not UGD ( 5.0 ± 0.2 : 3.6 ± 0.6 , p < 0.01 ) . Conclusion Transcutaneous electrical stimulation was beneficial for STC , with response weakly associated with UGD . As measured by NTS , STC children with NUGM responded slightly more , but with significantly greater increased transit compared to those with UGD . Higher numbers are needed to determine if the difference is important PURPOSE We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children . We design ed a prospect i ve r and omized trial with sham control for this evaluation . MATERIAL S AND METHODS We prospect ively r and omized 25 girls and 12 boys with an average age of 7.6 years ( range 4 to 12 ) into the test ( active treatment ) or sham ( superficial scapular electrical stimulation ) group . A total of 20 sessions , 20 minutes each ( 10 Hz ) were performed 3 times weekly . The criteria used to evaluate the rate of success were 1 ) self-reported cure , or significant , mild or no improvement ; 2 ) visual analogue scale ( level of success 0 to 10 ) ; 3 ) percent improvement ; 4 ) modified Toronto score ; and 5 ) maximum voided volume , average voided volume and number of voids daily based on bladder diary entries . After completion of the 20 sessions controls who were not cured underwent active treatment . RESULTS A total of 21 patients in the test group and 16 in the sham group underwent treatment . Among the active treatment group 61.9 % of parents reported cure . In the sham group no parent reported cure ( p < 0.001 ) . Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group , while 1 parent in the sham group indicated a score of 9 ( p = 0.002 ) . Additionally 100 % improvement was reported by 12 parents in the test group and no parent in the sham group . Toronto score improved significantly in the test group ( p < 0.001 ) and sham group ( p = 0.008 ) . However , the score was reduced more significantly in the test group compared to the sham group ( p = 0.011 ) . In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased . After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured . CONCLUSIONS This is the first known r and omized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder BACKGROUND The aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation ( TENS ) treatment improves the results of st and ard urotherapy in children with overactive bladder ( OAB ) symptoms . MATERIAL AND METHODS Sixty-two children with symptoms of OAB and incontinence were included . The children were r and omized either to st and ard urotherapy treatment alone or a combination of st and ard urotherapy and TENS . The effect variables were taken from a voiding-drinking diary : number of voiding , number of incontinence episodes , and maximum voided volume . RESULTS Both treatment groups had good treatment results , with no significant difference between the groups . In the st and ard treatment group 13/28 ( 46 % ) were completely dry and 11/28 ( 40 % ) had a decrease in incontinence episodes , compared to 16/24 ( 67 % ) and 3/24 ( 13 % ) , respectively , in the st and ard+TENS group ( p=0.303 ) . The number of voiding decreased in two-thirds of the patients in both groups . However , maximal voided volume only increased in the st and ard treatment group . Subjectively 72 % and 80 % considered themselves significantly improved or free of symptoms . Previous treatment was registered in 15/55 ( 27 % ) . All efficacy variables decreased in those with previous treatment , but with no difference between the st and ard and st and ard+TENS treatment groups . The only difference noted was when comparing the children without previous treatment in the groups : a significantly higher proportion were completely dry in the TENS group ( 12/18 [ 71 % ] versus 10/22 [ 48 % ] , p=0.05 ) . CONCLUSION Our results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy+TENS , whereas a tendency to difference was found in children without previous treatment . Thus with good urotherapy support , TENS only seems to have marginal additional effects on OAB symptoms INTRODUCTION Overactive bladder ( OAB ) is the most prevalent voiding disorder in childhood , and its main manifestation is urinary urgency . In general , urotherapy and anticholinergics are the first choices of treatment . Parasacral Transcutaneous Electrical Neural Stimulation ( PTENS ) was introduced as an alternative for the treatment of detrusor overactivity in children , but treatment protocol s described to date require several sessions per week or long-lasting sessions , making it difficult for the child to adhere to the treatment . Thus , this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children . STUDY DESIGN This prospect i ve , r and omized controlled trial included 16 children with OAB . Children were divided into two groups : CG ( urotherapy and electrical stimulation placebo ) and EG ( urotherapy and PTENS ) . For both groups , therapy was delivered in 20 weekly sessions , of duration 20 min each . Placebo electrical stimulation was done in the scapular area . The children were evaluated prior to treatment ( T1 ) , at the end of the 20 sessions ( T2 ) , and 60 days after the completion of treatment ( T3 ) , with a 3-day voiding diary , visual analogue scale ( VAS ) , Rome III diagnostic criteria , and the Bristol Scale . RESULTS The groups were similar in age , gender , and ethnicity . In the initial assessment , all children , in both groups , had urgency and incontinence , 50 % in each group had constipation , and enuresis was present in seven children ( 87.5 % ) in the EG and six ( 75 % ) in the CG . No differences were found between the groups regarding the volumetric measurements made in the voiding diary , urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale . Sixty days after treatment , a significant improvement was found in the EG group ( p = 0.03 ) regarding urgency ( Table ) , as well as an increase in dry nights in those presenting with enuresis ( p = 0.03 ) . No difference was noted regarding urinary incontinence ( Table ) . At the end of 20 sessions and after 60 days of treatment , those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS ( p = 0.05 and 0.04 , respectively ) . CONCLUSIONS Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis , and in the perception of those responsible for the children . Further studies with larger population s are needed to corroborate these results BACKGROUND Until now no confirmatory clinical trial in children suffering from nonneurogenic overactive bladder ( OAB ) and urinary incontinence could demonstrate superiority for antimuscarinics over placebo . OBJECTIVES The following study was conducted to prove efficacy and tolerability of propiverine compared to placebo . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blind , placebo-controlled phase 3 trial with parallel-group design in children aged 5 - 10 yr was performed . Prior to the 8-wk medical therapy urologic baseline diagnostics , a 3-wk lifestyle advice ( urotherapy ) was established . INTERVENTION After re-evaluation of in- and exclusion criteria and uroflowmetry , only children fulfilling the requested criteria were allocated to a body-weight-adjusted therapy ( 10 or 15 mg propiverine twice daily or corresponding placebo ) . MEASUREMENTS Efficacy parameters derived from bladder diary and a micturition volume protocol . Decrease in voiding frequency per day was chosen as primary efficacy parameter ; secondary endpoints included voided volume and incontinence episodes . A safety assessment was conducted . RESULTS AND LIMITATIONS Of 171 r and omized children , 87 were treated with propiverine and 84 with placebo .  The primary efficacy parameter showed a decrease in voiding frequency ( -2.0 episodes for propiverine versus -1.2 for placebo ; p=0.0007 ) . Superiority could also be demonstrated for voided volume ( 31.4 vs. 5.1 ml ; p<0.0001 ) and incontinence episodes ( -0.5 vs. -0.2 episodes per d ; p=0.0005 ) . The trial design did not allow for separate evaluation of the effect of urotherapy prior to medical treatment . Propiverine was well-tolerated in children . Altogether 23 % of side-effects were reported for propiverine and 20 % for placebo . CONCLUSIONS This clinical trial showed superior efficacy of propiverine over placebo and good tolerability for the treatment of children suffering from OAB and urinary incontinence . An important additional factor for the success of the trial was a modified trial design with previous urotherapy . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00603343 PURPOSE Transcutaneous electrical stimulation ( TES ) ( 3 sessions/wk ) over the abdomen stimulated bowel functions in a r and omized controlled trial . This pilot study assessed whether daily TES at home with a safe , portable machine would be possible and more efficacious than trial results . METHODS Eleven patients ( 6 male/5 female ; mean age , 14 years ; range , 12 - 18 years ) with slow-transit constipation who relapsed or responded poorly in the trial were recruited ( 11 + /- 5 months later ) . An EPM-IF-4160 ( Fuji Dynamics , Hong Kong ) portable machine ( sine waveform , 4 kHz carrier frequency , 80 - 160 Hz beat frequency , intensity <33 mA ) delivering interferential current ( 2 electrodes over epigastrium + 2 over kidneys ) was applied 1 hour daily at home . Continence diaries were kept for 1 month before and 2 months during treatment . RESULTS All children completed more than 1 month of treatment after baseline recording . Defecation increased in 9 of 11 children , and soiling decreased in 4 of 11 children . There was a significant increase in total episodes of defecation per week ( mean + /- SD , 2.5 + /- 2.1 vs 6.7 + /- 4.4 ; P = .008 ) and a nonsignificant decrease in soiling ( 3.8 + /- 1.6 vs 1.1 + /- 0.5 episodes/wk , P = .1 ) . Daily stimulation does not affect abdominal pain . No adverse events occurred . CONCLUSIONS Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES . Home TES may be a novel treatment of intractable slow transit constipation , avoiding hospital visits PURPOSE We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant , nonneuropathic bladder sphincter dysfunction . MATERIAL S AND METHODS In a prospect i ve study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and /or pharmacotherapy . The device for percutaneous electrical nerve stimulation consists of an interface cable , a surface electrode , a percutaneous needle and a portable stimulator . The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz . for 30 minutes once weekly . Every 6 weeks the children were evaluated . Evaluation parameters were urgency , daytime incontinence , voiding frequency , the uroflowmetry curve and bladder capacity . When favorable results were observed after 6 sessions , therapy was continued for another 12 sessions . In 24 children anticholinergics started before stimulation that had only a partial effect were continued during stimulation . RESULTS In 7 of the 28 children with urgency before therapy it disappeared after therapy and in 10 it improved . Of the 23 children with daytime incontinence before treatment 4 became dry after stimulation and in 12 incontinence decreased . Of the 19 patients who reported disturbed voiding frequency of less than 4 or more than 8 voids daily 16 achieved a normal frequency of 4 to 6 voids daily . In 21 children an abnormal uroflowmetry curve was observed before stimulation , while in 9 the flow curve was normal after therapy . Mean bladder capacity increased significantly from 185.16 to 279.19 ml . CONCLUSIONS Percutaneous electrical nerve stimulation has a significant effect on voiding frequency , the uroflowmetry curve and bladder capacity in children with nonneurogenic bladder sphincter OBJECTIVE To study the epidemiology of  micturition disturbances in teenagers . SUBJECTS AND METHODS A sub sample of 1034 teenagers previously evaluated at age 7 years was reinvestigated 10 years later . A postal question naire was used and a response rate of 71 % ( 736 ) obtained . Those who reported bladder symptoms were contacted by telephone for a detailed history concerning imperative urge , daytime incontinence , emptying difficulties and bedwetting . RESULTS There was a general decrease in the frequency and intensity of symptoms from 7 to 17 years of age . At age 17 at least one symptom was reported by 5.9 % of the girls and 0.9 % of the boys . Overall the symptoms were regarded as mild or moderate . CONCLUSION At age 17 years , micturition disturbances were reported infrequently and few subjects wanted medical help BACKGROUND Solifenacin , an effective , well-tolerated treatment for adult overactive bladder ( OAB ) symptoms , has not been evaluated in placebo-controlled paediatric clinical trials . OBJECTIVES To evaluate the efficacy and safety of once-daily oral solifenacin suspension in OAB patients aged 5-<12 yr ( children ) and 12-<18 yr ( adolescents ) . DESIGN , SETTING , AND PARTICIPANTS The study involved a 4-wk urotherapy run-in followed by 1:1 r and omisation to 12-wk double-blind solifenacin or placebo treatment alongside urotherapy . INTERVENTION Solifenacin paediatric equivalent doses ( PEDs ) of adult doses : 2.5 mg , 5 mg , 7.5 mg , and 10 mg . The starting dose was PED 5 mg ; all patients were titrated to an optimum dose at 3-wk intervals over 9 wk , result ing in ≥3 wk at the optimum dose before end of treatment ( EoT ) . OUTCOME MEASUREMENTS AND STATISTICS Superiority of solifenacin versus placebo in change from baseline to EoT for mean volume voided/micturition ( MVV , primary endpoint ) ; daytime maximum volume voided/micturition ( DMaxVV ) ; incontinence episodes ( mean/24h ) ; mean number of incontinence-free days or nights/7 d ; micturition frequency ; and Micturition frequency adjusted for baseline total voided volume ( VTB ) as an exploratory parameter ) . Efficacy parameters were analysed using analysis of covariance . Safety parameters ( treatment-emergent adverse events , serious adverse events , laboratory variables , vital signs , electrocardiogram , postvoid residual volume ) are summarised using descriptive statistics . RESULTS AND LIMITATIONS In children , solifenacin was superior to placebo in terms of the change from baseline to EoT for MVV  ( solifenacin-placebo difference 12.1ml , 95 % confidence interval [ CI ] 0.2 - 24.0 ; p=0.046 ) , DMaxVV ( difference in adjusted mean change from baseline for solifenacin-placebo 31.9ml , 95 % CI 4.3 - 59.5 ; p=0.024 ) , VTB-adjusted micturition frequency ( p=0.028 ) . Other endpoints were not significantly different . Solifenacin was well tolerated . For adolescents , it was not possible to draw firm efficacy conclusions because of the low numbers recruited . CONCLUSIONS Once-daily solifenacin oral suspension in children with OAB was superior to placebo for MVV ( primary efficacy endpoint ) and was well tolerated . PATIENT SUMMARY In this 12-wk study , a once-daily oral suspension of solifenacin in children aged 5-<12 yr with overactive bladder was superior to placebo in increasing mean volume voided/micturition , the primary efficacy variable in the study . Solifenacin was well tolerated , with a low incidence of dry mouth and constipation . This study is registered at Clinical Trials.gov as NCT01565707 OBJECTIVE To determine the prevalence and natural history of urinary symptoms and incontinence among healthy adolescent schoolchildren . SUBJECTS AND METHODS A prospect i ve longitudinal study using a confidential question naire administered to an original cohort of 1176 local schoolchildren at 11 - 12 years and again at 15 - 16 years old . RESULTS There was a decrease in the prevalence of urinary symptoms with age . Daywetting was reported by 12.5 % of children aged 11 - 12 years and 3.0 % of children aged 15 - 16 years . Nocturnal enuresis was reported by 4.7 % of children at 11 - 12 years and 1.1 % at 15 - 16 years . Some of the children reporting daywetting and nocturnal enuresis at 15 - 16 years old had not reported these symptoms at 11 - 12 years old . CONCLUSION Urinary symptoms become less prevalent with age , but are reported by a significant number of healthy schoolchildren PURPOSE We evaluated the efficacy of transcutaneous neuromodulation to treat urinary urgency and urge incontinence in children with nonneurological bladder dysfunction . MATERIAL S AND METHODS Surface neuromodulation was delivered via skin electrodes away from the genital region for a short duration daily on a home treatment basis . Clinical outcome was measured by 3 tools previously tested for reliability including the frequency volume chart , urgency visual analog scale and accident diary ( " Dry Pie " ) . RESULTS After at least 1 month of application dryness had improved in 73.3 % of children , mean urgency score had improved to equate action at urge as being ' easy to hold on ' and there was a significant increase in mean voided volume . CONCLUSIONS Initial evaluation of the home application of surface neuromodulation in children with urgency and /or urge incontinence revealed positive results and warrants a r and omized controlled investigation . The finding that children were not completely dry with this treatment in isolation suggests that further study is needed to identify optimal treatment duration and stimulus intensity PURPOSE We determined the effectiveness of 2 methods to treat overactive bladder in children using intragroup and intergroup comparisons in a r and omized clinical trial . MATERIAL S AND METHODS Nine boys and 19 girls with a mean ± SD age of 6.4 ± 2.18 years were r and omly divided into group 1-parasacral transcutaneous electrical stimulation with placebo drug and group 2-oxybutynin with sham scapular electrical therapy . Success was assessed by 1 ) the rate of complete symptom resolution , 2 ) a visual analog scale of 0 to 10 , 3 ) the dysfunctional voiding score system , 4 ) voiding diary records , 5 ) Rome III criteria and 6 ) side effect frequency in each group . RESULTS A total of 13 and 15 patients were r and omized to groups 1 and 2 , respectively . Symptoms completely resolved in 6 patients in group 1 ( 46 % ) and 3 in group 2 ( 20 % ) ( p = 0.204 ) . A statistically significant improvement was found in the 2 groups in the dysfunctional voiding score system and voiding diary records . However , no statistically significant difference was found between the groups in the visual analog scale score , voiding frequency , and maximum and mean voided volume ( p = 0.295 , 0.098 , 0.538 and 0.650 , respectively ) . Constipation improved in 100 % of group 1 patients but in only 55 % in group 2 ( p = 0.031 vs 0.073 ) . Group 1 showed no side effects while dry mouth , hyperthermia and hyperemia developed in 58 % , 25 % and 50 % of group 2 patients ( p = 0.002 , 0.096 and 0.005 , respectively ) . Treatment was discontinued by 13.3 % of patients in group 2 . CONCLUSIONS Parasacral transcutaneous electrical stimulation was as effective as oxybutynin to treat overactive bladder in children . However , transcutaneous parasacral electrical stimulation was more effective against constipation and showed no detectable side effects . Oxybutynin was more effective for decreasing voiding frequency
target: No significant difference was found between other treatments .
  Conclusion Compared with antimuscarinic drugs , PTENS was associated with significant better efficacy considering MVV , but more constipation events in de novo OAB children .
  Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy .
background: Objective To compare these managements focusing on the efficacy and safety to treat overactive bladder ( OAB ) in children through network meta- analysis ( NMA ) .