Transurethral Intravesical Electrotherapy for Neurogenic Bladder Dysfunction in Children with Myelodysplasia: A Prospective, Randomized Clinical Trial

Abstract

Myelomeningocele is the most common cause of neurogenic bladder dysfunction in children. Urinary incontinence is socially disabling for many of these children and undetected elevations in detrusor pressure can lead to serious upper tract damage. Sensory receptors in the bladder mucosa and submucosa provide afferent information to the central nervous system regulating the micturition reflex. Since 1959 Katona and several other investigators have used intravesical electrotherapy for diagnosis and treatment of the neuropathic bladder. Our objective was to conduct a randomized, sham controlled and blinded clinical study on the efficacy of transurethral intravesical electrotherapy in treating urinary incontinence in the myelodysplastic child. A total of 36 children was enrolled in the study and 31 completed the entire protocol. Of the patients completing the study 13 were randomly selected to serve as an internal sham control having the electrocatheter placed without activating the stimulator. These patients were subsequently treated with a 3-week course of electrotherapy. The remaining 18 patients completing the study were randomly selected to undergo 2, 3-week courses of intravesical bladder stimulation. Urodynamic studies were performed before and after each treatment series. Detailed daily questionnaires were submitted to each participant covering subjective improvement in urinary continence and any development of bladder sensory awareness. Analysis of the urodynamic data and questionnaires failed to reveal any statistically significant increase in bladder capacity, development of detrusor contractions, improvement in detrusor compliance or the acquisition of bladder sensation allowing timely intermittent catheterization preventing urinary incontinence.