Eletroestimulação nervosa transcutânea parassacral na enurese primária monossintomática

Abstract

Nocturnal enuresis (NE) is an intermittent and involuntary loss of urine during sleep. It is classified as monosymptomatic, when only nocturnal loss of urine is present and non-monosymptomatic nocturnal, besides nocturnal loss of urine daytime lower urinary tract symptoms occur. It is believed that transcutaneous parasacral electrical stimulation (TCPSE) has a physiological recondition effect redesigning synapses by neuronal plasticity. Its use in children with lower urinary tract dysfunction is well known, however, no study has evaluated its effects on monosymptomatic nocturnal enuresis. To assess the effectiveness of TCPSE in the treatment of primary monosymptomatic enuresis. This prospective controlled clinical trial enrolled 45 children (29 girls) over 6 years of age with primary enuresis treated in the Pediatric Urology Clinic of HU/CAS-UFJF. The children were divided at random into 2 groups, control (GC), treated with behavioral therapy and experimental (GE), treated with behavioral therapy and 10 session of TCPSE. TCPSE were performed with the electrodes placed in the sacral region (S2/S3) of the patient. Sessions had always the same pattern, with 20 minutes duration, frequency of 10 Hz with a generated pulse of 700μs and intensity determined by the child's sensitivity threshold. Sessions were done three times a week on alternate days. Patients of both groups were accompanied with intervals of 2 weeks in the first month and monthly for 6 consecutive months. The percentage of dry nights at the onset of treatment was 23% in GC and 22% in GE (p = 0,82) and 51% and 69% at the end of the treatment, respectively (p = 0,02). Separating the groups in children younger and older than 10 years of age, it was observed a significant improvement in dry nights in children younger than 10 in GC (17,6 to 39.7% p=0,02) and no improvement in the group older than 10 years of age (32,4 to 67,6% - p=0,108) after 6 months follow-up. When we evaluated each gender individually we found a statistical difference in GE just before treatment (11,9% in boys and 27,4% in girls p=0,03), which became similar at the end of follow-up (63.3% and 71,9%, respectively p=0,39). Analyzing the amount of dry nights in an interval of 30 days, it was observed that there was a significantly greater increase in the group undergoing TCPSE when compared to CG (14,11 ± 6,63 dry nights in GE and 8,28 ± 6,42 dry nights in GC for 30 days p = 0.0054). Subdividing the experimental group by age (greater and less than 10 years), we observed that this increase in the number of dry nights was similar (p=0,971), and the same similarity occurred when GE was subdivided according to sex (p=0,312). Treatment of monosymptomatic enuresis with 10 sessions of TCPSE associated with behavioral treatment proved to be effective although no patient was cured after 6 months follow-up. However, no patient had complete remission of symptoms.