Concomitant use of TENS with oxybutynin effective in paediatric urge incontinence
Use of transcutaneous electrical nerve stimulation (TENS) in combination with oxybutynin in the treatment of urge incontinence in children is superior to both TENS and oxybutynin monotherapy in terms of efficacy, a study has shown. Treatment with TENS also helps reduce the risk of oxybutynin-induced elevated postvoid residual urine volume.
The study randomly assigned 66 children (mean age 7.3 years) with urge incontinence to one of the following treatment groups: active TENS plus active oxybutynin (group 1; n=22), active TENS plus placebo oxybutynin (group 2; n=21) and active oxybutynin plus placebo TENS (group 3; n=23).
Active or placebo TENS was administered over the sacral S2 to S3 outflow for 2 hours daily, whereas active or placebo oxybutynin was given at a dose of 5 mg dose twice daily. The intervention lasted for 10 weeks. Primary outcome was the number of wet days/week, while secondary outcomes included severity of incontinence, frequency, maximum voided volume (MVV)/expected bladder capacity (EBC), average voided volume (AVV)/EBC and visual analogue scale (VAS) score.
Combination therapy was superior to oxybutynin monotherapy (p=0.05), with the likelihood of response being 83-percent higher in children receiving combination therapy. Compared with active TENS monotherapy, active TENS/active oxybutynin was also significantly more effective in terms of improvement in number of wet days/week (mean difference [MD], -2.28; 95 percent CI, -4.06 to -0.49), severity of incontinence (MD, -3.11; -5.98 to -0.23) and voiding frequency per day (MD, -2.82; -4.48 to -1.17).
Urge incontinence is defined as an inability to suppress voiding with urgency, and overactive bladder is a common disorder of urge incontinence. Children with this disorder have small volume voids during the day, while those with infrequent voiding (<4 voids per day) may have voiding postponement. [Aust Prescr 2014;37:192-5]