liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Anogenital electrical stimulation as treatment of urge incontinence in children
Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
2001 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 87, no 4, 366-371 p.Article in journal (Refereed) Published
Abstract [en]

Objectives To evaluate retrospectively the result of anogenital afferent stimulation (AGAS) in neurological healthy children with therapy-resistant urge incontinence.

Patients and method The study included 48 children (24 girls and 24 boys, 5–14 years old) with a diagnosis of bladder instability verified by cystometry in all. Anogenital afferent stimulations were applied using a battery-powered dual constant-current stimulator. The children were stimulated continuously at 10 Hz for 20 min once or twice daily and if required the children and/or the parents continued to apply the treatment at home. For home stimulation a single (anal) channel stimulator was used. The patients were instructed to stimulate for 20 min at maximum intensity two to three times a week until the effects were optimal. The outcome was evaluated retrospectively by comparing voiding/incontinence diaries obtained before and at the follow-up 6–12 months after the end of treatment.

Results AGAS was applied at the clinic for a median (range) of 9 (4–20) times. Thirty-one children continued with home stimulation for another 25 (5–96) sessions. At the follow-up, 18 children were cured and another seven improved, with a leakage score of less than half that before treatment. The treatment was well tolerated by most children.

Conclusions Anogenital afferent stimulation is an effective, potentially curative treatment in children with severe urge incontinence. Home stimulation is a well accepted adjuvant to treatment at the clinic and improves the outcome.

Place, publisher, year, edition, pages
2001. Vol. 87, no 4, 366-371 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25251DOI: 10.1046/j.1464-410X.2001.00109.xLocal ID: 9690OAI: oai:DiVA.org:liu-25251DiVA: diva2:245579
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-09-10Bibliographically approved
In thesis
1. To void at will: lnvestigation and treatment of children with bladder dysfunction
Open this publication in new window or tab >>To void at will: lnvestigation and treatment of children with bladder dysfunction
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Improvements in diagnostic and treatment procedures have made it possible to obtain a normal kidney function and continence for most children with bladder dysfunction. However, in the daily clinical work further diagnostic and treatments procedures may be required when traditional methods fail to help the child. The aims of the present studies were to evaluate such diagnostic and treatments alternatives.

A 4-hours observation test of voiding pattern was evaluated in 50 healthy newborns, as reference values were lacking for this age group. Normal values for voiding frequency, intervals, volume and residual urine were established. All parameters varied greatly both inter- and intraindividually. Residual urine occurred after some voidings in most newborns.

At our clinic, children are catheterised without anaesthesia or sedation, following a special concept of preparation. When evaluating this routine most children (93/99) tolerated the procedure well. Five girls and one boy (or their parents) reported the catheterisation to be "very painful", without requiring that the procedure was interrupted.

The diagnostic value of the bladder cooling tests (BCT) was evaluated in 108 children with neurogenic bladder dysfunction. The BCT could identify a functional sacral reflex arch in children without voiding contractions or confirm a suspected lower motor neurone lesion. A positive test in children older than 6 years verified the diagnosis neurogenic bladder dysfunction.

The effect of anogenital afferent stimulation (AGAS) was retrospectively evaluated in 48 children with therapy resistant urge incontinence. Thirty-eight percent were cured, another 15 % improved. AGAS is a useful, potentially curative treatment in children with severe urge incontinence.

Intravesical electrical stimulation (IVES) was offered as alternative treatment to 44 children with bladder emptying problems, 20 of neurogenic origin. Twenty-eight children, 8 with neurogenic problems, had long term normalisation of their voiding and 11/15 children could discontinue clean intermittent catheterisation. IVES seems to be a promising method for treatment of underactive detrusor in children.

Conclusions: Some investigative methods aimed at children with suspected bladder dysfunction were evaluated together with two new treatment modalities involving electrical stimulation of afferent nerve fibres. Anogenital or intravesical electrical stimulation represents alternative options for children with urge incontinence or underactive detrusor when standard treatments fail.

Abstract [sv]

Förbättrad diagnostik och utveckling av nya behandlingmetoder har gjort det möjligt att bevara en normal njurfunktion och kontinens för flertalet barn med blåsstörningar. l det dagliga kliniska arbetet uppkommer emellertid ofta krav utrednings- och behandlingsalternativ när traditionella metoder inte räcker till. Syftet med dessa studier var att utveckla och utvärdera nya diagnostiska och terapeutiska metoder för barn med blåsstörning.

Ett 4-timmars observationstest av miktiansmönstret har utvärderats hos 50 friska nyfödda barn, eftersom referensvärden fattades för denna åldersgrupp. Normalvärden för miktionsfrekvens, intervall, volym och resturin har har tagits fram och visar stora variationer i samtliga miktiansparametrar såväl inter- som intraindividuellt. Flertalet nyfödda barn hade resturin efter någon eller flera miktioner.

Vid PNUT-enheten vid Barn- och ungdomsmedicinska kliniken kateteriseras så gott som samtliga barn transuretra!t utan anestesi eller sedering men efter noggrann förberedelse enligt speciellt program. Vid utvärdering tyckte flertalet (95/99) att konceptet var bra/mycket bra. Fem flickor och en pojke (eller deras föräldrar) tyckte att kateteriseringen gjorde "mycket ont", men utan att kräva att proceduren skulle avbrytas.

Det diagnostiska värdet av köldtest har utvärderats på 108 barn med neurogen blåsrubbning. Köldtestet kunde påvisa en fungerande sakral reflexbåge även hos barn utan miktianskontraktion alternativt bekräfta en misstänkt nedre motorneuronskada. Ett positivt test hos barn äldre än 6 år verifierar diagnosen neurogen blåsrubbning

Effekten av anagenital afferent stimulering (AGAS) har utvärderats retrospektivt hos 48 barn med terapiresistent trängningsinkontinens. Trettiotvå procent blev botade och ytterligare 15 % blev förbättrade. AGAS är en användbar, potentiellt kurativ behandlingsmetod för barn med svår trängningsinkontinens.

lntravesikal elektrisk stimulering (IVES) erbjöds som alternativ behandling till 44 barn med blåstömningsproblem, hos 20 orsakat av neurogena skador. Tjugoåtta barn, 8 med neurogena problem, fick en bestående normalisering av miktionen och 11/15 barn kunde avsluta behandlingen med ren intermittent kateterisering. lVES tycks vara en lovande metod att behandla svag detrusarfunktion hos barn.

Sammanfattning: Olika undersökningmetoder för barn med blåsdysfunktion har utvärderats liksom två nya behandlingsmodeller med elektrisk stimulering av afferenta nervfibrer. Anagenital och intravesikal elektrisk stimulering representerar alternativa möjligheter att behandla barn med trängningsinkontinens respektive svag detrusar när traditionella behandlingmetoder inte hjälper.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 60 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 713
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26652 (URN)11217 (Local ID)91-7373-154-4 (ISBN)11217 (Archive number)11217 (OAI)
Public defence
2002-01-11, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-10Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Gladh, GunillaMattsson, SvenLindström, Sivert

Search in DiVA

By author/editor
Gladh, GunillaMattsson, SvenLindström, Sivert
By organisation
PediatricsFaculty of Health SciencesDepartment of Biomedicine and Surgery
In the same journal
BJU International
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 100 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf