INTRODUCTION: Joint hypermobility is a condition in which there is extreme mobility of the joints, often leading to manifest symptoms. Overactive bladder (OAB) is a commonly associated problem. The purpose of the present study was to evaluate the use of transcutaneous electrical nerve stimulation (TENS) as a sole treatment for children with OAB associated with benign joint hypermobility syndrome (BJMS).
METHODS: A total of 26 children with OAB and without voiding dysfunction or constipation participated in the study. Their ages ranged from 5-14 years. All patients were evaluated by uroflowmetry to exclude patients with high flow rate, ultrasound of the urinary tract to exclude organic causes and high postvoid residual urine, and urine analysis and culture to exclude infection. None of the patients were taking anticholinergics during the investigation. All patients were treated by TENS, using 2 superficial 4 cm electrodes that were placed on each side of sacral segment 3. Sessions lasted for 20 minutes and were conducted every other day, to a maximum of 20 sessions. Sessions were terminated if the physician and parent agreed that the child had attained complete success. All parents (or patients) completed a voiding diary before treatment and for 1 month after the last session. Improvement was assessed on an analog scale. Chi-square was used to test the hypotheses that response rates were the same in each category with regard to patient age and sex.
RESULTS: The total number of sessions ranged from 12-20. Out of 26 patients, 19 (73%) complained of urge incontinence following treatment (13 girls; 6 boys). Of these 19 patients, 15 had associated nocturnal enuresis (11 girls; 4 boys). None of the 7 patients without urge incontinence had enuresis. Eleven patients (42.36%) had complete clinical improvement, 6 (23%) had excellent improvement, 3 (11.54%) had mild improvement, and 6 (23%) had no change. There were no significant differences in the degree of improvement regarding the patient's sex or age (P > .05).
CONCLUSION: Transcutaneous electrical nerve stimulation shows promise as an alternative to pharmacological treatment for OAB symptoms in children with BJHS.
Tarek Salem, Hashim Hafez, Manal Ali
Submitted September 30, 2010 - Accepted for Publication October 23, 2010
KEYWORDS: Benign joint hypermobility syndrome; Transcutaneous electrical nerve stimulation; Overactive bladder.
CORRESPONDENCE: : Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ( ).
CITATION: Urotoday Int J. 2010 Dec;3(6).
doi:10.3834/uij.1944-5784.2010.12.10