Functional electrical stimulation for management of urinary incontinence in children with myelomeningocele: a randomized trial

To report the efficacy of transcutaneous functional electrical stimulation (FES) in children with refractory neuropathic urinary incontinence secondary to myelomeningocele (MMC). Thirty children with history of MMC (12 girls and 18 boys, mean age 6.7 +/- A 3.6 years) with refractory urinary incontinence were enrolled in this study. They were randomly allocated to treatment (FES, 15 children) and control (sham stimulation, 15 children) groups. All patients underwent urodynamic study (UDS) before and 6 months after FES considering detrusor leak point pressure (DLPP), mean maximal detrusor pressure, and mean maximal bladder capacity. Daily incontinence score, frequency of pad changing, and enuresis were also assessed before and 6 months after treatment. A 15-course FES was performed for 15 min and 3 times per week. Children were followed for at least 6 months. Of UDS variables, DLPP increased significantly from 32 +/- A 10.7 cmH(2)O before treatment to 55.6 +/- A 24.9 cmH(2)O in treatment group after 6 months (P < 0.03). Daily incontinence score (range 0-3) improved significantly in treatment group from 2.7 +/- A 0.4 before treatment to 1.3 +/- A 0.9 after treatment compared with sham stimulation group (P < 0.02). This type of electrical stimulation is a safe, noninvasive, and effective modality to improve urinary incontinence in myelomeningocele children and can be used at home.