Efficacy of Transcutaneous PTNS in Children with Functional Voiding Disorder

• 30 Dec 2020 08:47:57 PM
• |Pediatic Urology

This article provided addresses the efficacy of Transcutaneous PTNS in children with Functional Voiding Disorder.

Comments(3)

• 

  Venugopal P

  31 Dec 2020 10:23:03 AM

  Dear All,

  I must thank Prasanna for commenting on the article provided. Most of the studies on Transcutaneous Posterior Tibial stimulation have been performed on OAB in Adults but its effectivity in children is assessed in this study.

  Many children with Functional Voiding Dysfunction (FVD) can be managed easily with Urotherapy—a conglomerate term that implies treating the child with multimodal therapy. A small but definite group of individuals who do not respond to a comprehensive Urotherapy approach will require a more involved management schema.

   

  			Step 4  Aug Cystoplasty	Cystectomy
  		Step 3            Botox		Sacral Neuromodulation
  	Step 2  Anti Muscarinic Drugs			Posterior Tibial Nerve stimulation
  Step 1         Local Treatments, Behavioural Treatments and Life Style Modifications

  Graduated, stepwise scheme for OAB Treatments (Adults)

  The authors conducted a rigorous investigation, involving a prospective, randomized, controlled, single-blinded study of children with FVD, primarily involving storage phase dysfunction, namely overactive bladder symptoms. They noted a 50% cure rate, which had a lasting effect even 2 years after the treatment was completed.

  Like other treatment modalities for FVD, these authors have shown that there is not a ‘one-shoe-that-fits-all’ mentality should be avoided. The study showed that there was good response to this modality of treatment and that it should be considered prior to more invasive treatments is contemplated.

  Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome was first described by McGuire et al (1983) and Stoller et al (1987). But their efforts did not gain popularity till Sacral Neuromodulation emerged as an option. This being a major undertaking and this made researchers to look at Posterior Tibial Nerve Stimulation with a new stimulus.

  Percutaneous posterior tibial nerve stimulation is a type of neuromodulation, whose therapeutic effect is explained by the modulation of reflex pathways; however, the exact mechanism behind neuromodulation is still not completely understood. The lumbar, sacral and coccygeal segmental nerves, with afferent and efferent fibres from L2-S4, innervate the lower urinary tract and the pelvic organs. With fibres from L4 to S3, the sciatic nerve descends to the lower extremities. The posterior tibial nerve is a branch of the sciatic nerve. The posterior tibial nerve shares nerve roots with the innervation of the lower urinary tract. It is assumed that there is cross-signaling between sympathetic and parasympathetic nerve terminals and synapses. According to this hypothesis, stimulation of the posterior tibial nerve causes a modulation of the lower urinary tract autonomous innervation.

  Though Needle is preferred, in children, probably patch will be more welcome as it is less invasive. Ofcourse much more informations are needed as regards its usage in Children but as the authors emphasized and as stated by Prasanna ‘we should explore this as an option, as it is not very invasive in this subset of children who are non responsive to the regular protocol’.

  With warm regards,

  Venu

   

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• 

  Dr. Prasanna Venkatesh M K

  31 Dec 2020 07:43:57 PM

  I would agree with Dr Venugopal Sir on his detailed note and comment. Probably in India we will do Botox after failed medical management, prior to the other therapies.

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  Dr. Roy Chally

  07 Jan 2021 07:30:43 PM

  Has anybody seen a covered meatus in these patients?