Evaluation of transcutaneous electrical posterior tibial nerve stimulation for the treatment of fecal and urinary leaks in children: Preliminary results

• Published in: Journal of pediatric surgery Vol. 50; no. 4; pp. 630 - 633
• Main Authors: Lecompte, Jean-François, Hery, Geraldine, Guys, Jean-Michel, Louis-Borrione, Claude
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adolescent; Child; Child, Preschool; Congenital malformations; Defecation - physiology; Fecal and urinary incontinence; Fecal Incontinence - congenital; Fecal Incontinence - physiopathology; Fecal Incontinence - therapy; Female; Follow-Up Studies; Humans; Male; Medullary abnormalities; Pediatric population; Pediatrics; Prospective Studies; Retrospective Studies; Surgery; Tibial Nerve; Tibial nerve stimulation; Transcutaneous Electric Nerve Stimulation - methods; Treatment Outcome; Urinary Incontinence - congenital; Urinary Incontinence - physiopathology; Urinary Incontinence - therapy; Urination - physiology; Fecal and urinary incontinence; Pediatric population; Tibial nerve stimulation; Congenital malformations; Medullary abnormalities
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2014.05.033

Abstract Objective To examine the effectiveness of posterior tibial nerve stimulation (PTNS) for the treatment of fecal and urinary incontinence in children with malformations of the bowel or neurological pathologies. Introduction Treatment of fecal and urinary leaks, in cases of congenital malformations remains a challenge. Recent studies in adults have shown the effectiveness of PTNS. Method Eight children: 4 with anorectal malformations, 3 with neurological causes (1 medullary lipoma, 1 Arnold Chiari malformation, 1 sacrococcygeal teratoma) and 1 with Hirschsprung's disease presenting with serious anal incontinence, despite extensive bowel management during at least 2 years, were treated with PTNS. Six children had associated urinary leaks. Jorge–Wexner score for defecation and Schurch score for urine were used before treatment and after the second and sixth months of stimulation. Results After six months, five patients had no more fecal leakage, two patients were improved and one did not respond. Five out of the 6 patients with urinary leaks were continent at 6 months. Conclusion PTNS is a noninvasive technique and painless modality which seems to be effective for the treatment of fecal and urinary leaks in children even with congenital digestive pathologies or neurological malformations. These results will be confirmed in a prospective study.