Does Adding TENS to Pelvic Floor Rehabilitation Effect on Urodynamics and Clinical Results in Children With Spina Bifida?

Abstract

Introduction: Children with spina bifida (SB) experience a reduced quality of life due to neurogenic bladder dysfunction and the risk of renal failure later in life. Pelvic floor rehabilitation (PFR) and transcutaneous electrical nerve stimulation (TENS) have gained prominence in recent years due to their positive effects in treating different types of bladder issues in both adults and children. Our study aims to investigate the effects of using these two methods together in children with SB and to delineate their potential value for clinical practice.

Materials and methods: Children with neurogenic bladder dysfunction due to SB who admitted to our spina bifida center were enrolled. Those patients, between 5 and 15 years of age, with only neurogenic detrusor overactivity (NDO) were randomly divided into two groups using an online computer application. While only the PFR was applied to Group PFR (n = 14), TENS was used in addition to this therapy in Group PFR + T (n = 14). The PFR sessions included abdominal massage, strength exercises, diaphragmatic breathing exercises, and contracting pelvic floor muscles. TENS was used in a standard fashion as previously described in patients with SB. Before and after treatment, patients' clinical data, dysfunctional voiding symptom score (DVSS), lower urinary tract symptoms, and quality of life scores due to urinary incontinence were evaluated. Urodynamic outcomes such as detrusor pressure, bladder capacity, contractility, and residual urine amount were also evaluated.

Results: Twenty eight children out of 750 SB patients were enrolled in our center. Children with only NDO due to SB were included in the study (Group PFR, mean age 8.3 ± + 2.7 years, 10 boys, four girls; Group PFR + T, 7.86 ± 2.03 years, eight boys, six girls). Treatment duration was 6 weeks (18 sessions). There was a decrease in voiding and lower urinary tract symptoms in both groups regardless of the use of TENS (p < 0.05). Maximum detrusor pressure significantly decreased only in the TENS group after treatment (from 82.143 ± 58.069 cmH2O to 58.077 ± 39.872 cmH2O) (p < 0.05). The difference in clinical parameters, quality of life scores and other urodynamic parameters were not found to be significant between groups.

Discussion: PFR and TENS may be effective in SB with NDO to reduce voiding symptoms, and protect bladder from increased pressures. PFR seems to be a useful conservative approach in patients with NDO, adjunt to standard treatment. Further studies are needed in delineation of a personalized holistic treatment approach in these patients.

Conclusion: Addition of TENS to standard PFR in NDO may be effective in reducing maximum detrusor pressures, however, it does not seem to specifically contribute for improving incontinence and incontinence-related quality of life.