Predictors of treatment failure with parasacral transcutaneous electrical nerve stimulation in children and adolescents with bladder and bowel dysfunction.

Introduction: Parasacral Transcutaneous Electrical Nerve Stimulation (parasacral TENS) has emerged as a promising treatment for children with Bladder and Bowel Dysfunction (BBD), being an efficient method without direct adverse effects. Little is known about clinical characteristics associated with poorer treatment outcomes in this specific patient group.

Objective: To evaluate potential clinical predictors of parasacral TENS treatment failure in children and adolescents with BBD.

Methods: This was a retrospective cohort study of children and adolescents aged 4-17 years diagnosed with BBD. All patients underwent three sessions of parasacral TENS for 20 min per week for a total of twenty sessions. Lower urinary tract symptoms (LUTS) were assessed by structured questionnaire, DVSS, and visual analog scale (VAS). Functional constipation (FC) was evaluated using the Rome IV criteria. Potential predictive clinical factors evaluated included age, daytime incontinence, nocturia, history of urinary tract infection (UTI), enuresis, pre-treatment DVSS scores, frequency, Rome IV sum, and fecal incontinence.

Results: Fifty-two patients were included in the study. The mean age (± standard deviation) was 7.8 ± 2.7 years, with a majority being female, 59.6 %. After treatment with parasacral TENS, complete LUTS response was achieved in 21 patients (40.4 %). A partial response occurred in 28 patients (53.8 %). In 3 patients (5.7 %), there was no response to treatment. As for FC, complete resolution was achieved in 35 (67.3 %) of the children, with 17 (32.7 %) remaining constipated. Among all participants, 16 (30.7 %) achieved complete resolution of both constipation and urinary symptoms. Of all the factors evaluated, history of UTI was identified as a clinical predictor of treatment failure for constipation in children with BBD undergoing parasacral TENS (p = 0.038; OR = 3.51; CI (1.04-11.84)).

Discussion: We suggest that children and adolescents with history of UTI are related to more severe FC, complicating treatment, requiring a multimodal and a more aggressive approach.

Conclusion: This study demonstrated that history of UTI is a clinical predictor of treatment failure for constipation in children and adolescents with BBD undergoing parasacral TENS.