Systematic review and meta-analysis on the role of transcutaneous electrical nerve stimulation in children with overactive bladder - Pooled analysis of nine randomized controlled trials.
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Abstract
Objective: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the management of overactive bladder (OAB) in children by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).
Methods: A systematic search of PubMed, Embase and the Cochrane Library was conducted to identify RCTs comparing TENS with standard therapies (urotherapy, sham TENS, or oxybutynin) in children with OAB. Inclusion criteria encompassed RCTs published between 2004 and 2024, reporting TENS as a primary intervention. Data were pooled using a meta-analysis framework, and heterogeneity was assessed using I2 statistics. Risk of bias was evaluated using the ROBVIS tool.
Results: Nine RCTs involving 382 children were included. Five studies compared active TENS with sham TENS, of which three reported superior efficacy for TENS, while two found no difference. Two studies compared TENS with oxybutynin; one demonstrated TENS superiority, while the other found comparable efficacy. One study showed TENS to be as effective as urotherapy, and another found that TENS combined with oxybutynin was superior to either treatment alone. The meta-analysis revealed that TENS significantly increased the likelihood of a full response compared to other treatments (OR 3.96, 95 % CI 2.46-6.38, p < 0.001). TENS was effective both as a standalone therapy (OR 4.34) and as an adjunct (OR 3.27). Parasacral TENS demonstrated a higher response rate than posterior tibial TENS.
Conclusion: TENS is an effective, non-invasive therapy for pediatric OAB, either as monotherapy or in combination with urotherapy or medication. However, variability in study protocols and limited long-term follow-up data highlight the need for standardized treatment protocols and larger RCTs to assess long-term outcomes, including relapse rates.
目的：通过对随机对照试验（RCTs）的系统评价和荟萃分析，评价经皮神经电刺激（TENS）治疗儿童膀胱过动症（OAB）的疗效。方法：系统检索PubMed、Embase和Cochrane图书馆，以确定比较TENS与标准治疗（尿路治疗、假TENS或奥施布宁）治疗OAB儿童的rct。纳入标准包括2004年至2024年间发表的rct，将TENS作为主要干预措施。使用荟萃分析框架汇总数据，并使用I2统计量评估异质性。使用ROBVIS工具评估偏倚风险。结果：纳入9项随机对照试验，涉及382名儿童。5项研究比较了活性TENS和假TENS，其中3项研究报告了活性TENS的疗效，而2项研究没有发现差异。两项研究比较了TENS与奥施布宁；一种显示出TENS的优越性，而另一种显示出类似的疗效。一项研究表明，TENS与泌尿治疗一样有效，另一项研究发现，TENS与奥昔布宁联合治疗优于单独治疗。荟萃分析显示，与其他治疗相比，TENS显著增加了完全缓解的可能性（OR 3.96, 95% CI 2.46-6.38, p < 0.001）。TENS作为单独治疗（OR 4.34）和辅助治疗（OR 3.27）均有效。骶旁TENS的反应率高于胫后TENS。结论：TENS是一种有效的、无创的儿科OAB治疗方法，无论是单独治疗还是联合泌尿治疗或药物治疗。然而，研究方案的可变性和有限的长期随访数据强调需要标准化的治疗方案和更大的随机对照试验来评估长期结果，包括复发率。普洛斯彼罗注册号：CRD420251114932。
期刊介绍：
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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