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

Direct link
Intravesical electrical stimulation in the treatment of micturition dysfunction 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.
2003 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 22, no 3, 233-242 p.Article in journal (Refereed) Published
Abstract [en]

Aims To evaluate the results of intravesical electrical stimulation (IVES) in an open prospective study to treat underactive detrusor in children. The treatment was offered as an alternative to clean intermittent catheterization (CIC).

Methods Forty-four children were included, 21 girls and 3 boys (6–16 years, md 10) with idiopathic, 9 girls and 11 boys (4–18 years; md 13) with neurogenic underactive detrusor. IVES was given by a catheter electrode in the bladder (cathode) with the anode attached to the suprapubic abdominal skin. Continuous stimulation at 20 or 25 Hz was delivered by battery powered stimulators giving unipolar square-wave pulses (0,2 or 0,7 ms). Stimulation intensity was adjusted individually according to the acceptance of the child (12–64 mA). IVES was initially given at the clinic but 18 children had additional treatment at home. Effect of treatment was monitored by micturiton/incontinence diary, reports of bladder sensation, recordings of urinary flow, residual volume and frequency of urinary tract infections.

Results The IVES-treatment was completed by 39/44 children. Long term normalization of the voiding (md 2,5 years follow up) was obtained for 20/24 children with idiopathic problems (83%) and 8/20 with neurogenic problems (40%). Another four had much improved bladder function. The neurogenic group required more stimulation sessions than the idiopathic group. Of those on CIC, 11/15 who completed IVES could discontinue the catheterization. The frequency of urinary tract infections and incontinence decreased significantly (P < 0.01).

Conclusions It is concluded that IVES is a promising method to treat the underactive detrusor in children.

Place, publisher, year, edition, pages
2003. Vol. 22, no 3, 233-242 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-25252DOI: 10.1002/nau.10078Local ID: 9691OAI: diva2:245580
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.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 713
National Category
Medical and Health Sciences
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)
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

Search in DiVA

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

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 49 hits
ReferencesLink to record
Permanent link

Direct link