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The use of TENs in the overactive
bladder
Christine Rhodes
CNS for Paediatric Urology
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How TENS works in pain
• TENS works by producing electrical impulses
that travel along the same nerve pathway as
your pain.
• These impulses interfere with the pain message
getting to the brain and override the pain
sensation
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Idiopathic Overactive Bladder
(OAB) • Urinary frequency, urgency with or without day and night
time wetting.
• Anti-cholinergic medications; first line treatment of
choice.
• Bladder re-training.
• Electrical stimulation now a alternative therapy to treat
OAB
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Why do we think it works on OAB?
The mechanics of electrical stimulation for OAB
seems far from being established.
• Electrical stimulation acts on the muscle fibres and the
reflexes.
• Activation of the sympathetic nerves (store) and the
inhibition of the parasympathetic nerves (pee) may have
a role to play.
• This would relax the bladder and inhibit detrusor over
activity ??
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Another thought
Sustained sacral root stimulation may reorganise
the human brain and its ability to excite the motor
cortex and as a result modulate LUT function.
Para-sacral transcutaneous electrical stimulation (TENS) for overactive
bladder (OAB)
Dialogues in paediatric urology 2011
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How long do we use it for?
• Every night for 12 weeks.
• 2 hours a day.
• Pulse width 170.
• Pulse rate 80-100.
• Mode N.
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How we start?
• Bring them into the ward.
• Mini bladder assessment/update.
• Show family how to use TENS (machine given to family
to keep)
• Place pads on child and demonstrate to the child how to
use machine.
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Nottingham Study
So far we have seen
• Girls x 20
• Boys x 4
Age
• Girls 9-14 years; mean age 11.1 years
• Boys 7-10 years; mean age 8.5 years
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Previous UTIs
• Girls 2/20 - had previous UTIs.
• Boys - none.
• 2 x girls had a UTI when they started on TENS.
• None of the children had Botox
• Bio-feedback girls x 8
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Continued
• Urodynamics x 10 all girls of which 6 of them went onto
have bio-feedback.
• Medication used in 22 at start of treatment.
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To Summarise
• 6/24 Dry
• 11/24 Improved
• 6/24 No improvement (2 need additional treatment-
Botox)
• 1 didn’t like the sensation of the TENS
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References
• Outcome of Treatment with Transcutaneous Electrical Nerve Stimulation (TENS) for Paediatric Bladder Over activity Arch Dis Child 2014;99:A168-A169 doi:10.1136/archdischild-2014-306237.385
• Nice guidelines Urinary incontinence: The management of urinary incontinence in women http://www.nice.org.uk/guidance/cg171/
• Evaluation of constipation after parascral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction- A pilot study. Journal of Pediatric Urology (2012) xx, 1-5.
• Efficacy of Transcutaneous Electrical Nerve Stimulation in Children with Overactive Bladder Refractory to pharmacology (2007) Official Journal of Urology Society international urology. Volume 70, Issue 5, page 980-983
• Ubirajara Barroso Jr., Rafael Tourinho, Patrıcia Lordelo, Piet Hoebeke, and Janet Chase. Electrical Stimulation for Lower Urinary Tract
Dysfunction in Children: A Systematic Review of the Literature Neuro-urology and Urodynamics 30:1429–1436 (2011)
• NeveusT, von Gontard A, Hoebeke P, et al.The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006; 176:314–24.
• Hoebeke P, Renson C, Petillon L, et al. Percutaneous electrical nerve stimulation in children with therapy resistant no neuropathic bladder sphincter dysfunction: A pilot study. J Urol 2002; 168:2605–8.
• Bower WF, Moore KH, Adams RD. A pilot study of the home application of transcutaneous neuromodulation in children with urgency or urge incontinence. J Urol 2001; 166:2420–2.
• Malm-BuatsiE, NeppleKG, BoytMA, etal.Efficacy of transcutaneous electrical nerve stimulation in children with OAB refractory to pharmacotherapy. Urology 2007; 70:980–3.
• Bordello P, Tales A, Veiga ML, et al. Transcutaneous electrical nerve stimulation in children with overactive bladders: A randomized clinical trial. J Urol 2010; 184:683–9.