Hypothesis / aims of study
Nocturnal enuresis has a negative impact on quality of life and psychological status of the patient,family and community. Most
patients respond to Behavioral modification , bladder training, drugs and alarm .However, both posterior tibial nerve stimulation
and magnetic stimulation were used in refractory cases , our aim is to evaluate its efficacy ,safety and tolerability in refractory
monosymptomatic nocturnal enuresis.
Study design, materials and methods
49 patients with refractory monosymptomatic nocturnal enuresis were included (37 boys and 12 girls, median age 13 years, range
9 to 19 ) and randomly divided into 2 groups . Group A (GA) 29 patients offered once weekly session of magnetic stimulation
using magnetic chair for 12 weeks the patient were seated on special chair containing a magnetic field generator to stimulate
pelvic floor muscles for 20 minutes and group B(GB) 20 patients received weekly session of posterior tibial nerve stimulation
(using personal computer based system) for 12 weeks . All patients were evaluated by history including pad test ,voiding and
nocturnal enuresis diary ,physical examination , urine analysis, and pelviabdominal ultrasound. Patients were followed after
sessions ,and 3 months later by voiding and nocturnal enuresis Diary .Both techniques were also compared as regard
complications and tolerability using Clavien complication grading .
Interpretation of results
The 2 groups were matched in baseline data Significant decrease in frequency of bedwetting episodes occurred in both
groups . ( from 5.2±1.3 to 1.3±0.1) GA and (from 6.1±0.9 to 1.4±0.5) in GB , p=0.002 . After treatment 24 patients in GA (82.7%)
had a partial or full response to magnetic stimulation, and 18 patient in GB (90%) achieved partial to full response to posterior
tibial nerve stimulation (p = 0.002). in GA 15 patients cured ,9 improved while 5 not responded while in Gb 11 cured 7 improved
and 4 failed According to voiding Diary , the mean functional bladder capacity increased 42% in all patients (P = 0.00).In GB minor
bleeding at needle site in 5 cases and temporary painful feeling in7 cases and classified as Grade 1 Clavien.
Concluding message
Extracorporeal magnetic stimulation is a noninvasive ,effective and painless therapy for primary monosymptomatic nocturnal
enuresis with comparable results to posterior tibial nerve stimulation. |
