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CONGRESS OF THE ESPU
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S20-3 (PP)
NEUROSTIMULATION THERAPY FOR NON-NEUROGENIC
OVERACTIVE BLADDER IN CHILDREN: A META-ANALYSIS
Nicolas FERNANDEZ
1
, Michael CHUA
1
, Jessica MING
1
, Jan Michael SILANGCRUZ
2
,
Fadi ZU’BI
1
, Armando LORENZO
1
and Roberto IGLESIAS LOPES
1
1) Hospital for SickKids, Urology, Toronto, CANADA - 2) St. Luke’s Medical Center, Quezon city, Philippines, Urology,
Quezon, PHILIPPINES
PURPOSE
Neurostimulation has been utilized to treat pediatric lower urinary tract dysfunction, specifically for
non-neurogenic overactive bladder (NNOAB). Available literature has contradictory results on its ef-
ficacy in treatment outcomes. We aimed to determine the efficacy and safety of the neurostimulation
therapy for NNOAB in children by meta-analysis of randomized control trials (RCTs).
MATERIAL AND METHODS
Systematic literature search was done on August 2016 in Pubmed, Scopus, Embase, Cochrane
library, Wiley Online Library, clinicaltrials.gov and WHO-International Clinical Trials Registry
Platform. Randomized controlled trials were evaluated according to Cochrane Collaboration risk of
bias assessment. The number of patients with post-treatment partial /PR (50%-89%), complete/CR
(>90%) and full /FR (100%) responses were extracted for relative risk (RR) and 95% confidence
interval (CI). Effect estimates were pooled using the Mantel-Haenszel method with random effect
model if significant inter-study heterogeneity (p<0.1) was noted.
RESULTS
Five studies with 245 patients were included. Overall effect estimates showed that compared to
standard urotherapy, neurostimulation showed significant better >50% (PR+CR+FR) response rate
(RR= 2.79, 95%CI 1.08 to 7.18). Subgroup analysis according the treatment setting showed clinic
based neurostimulation has significantly better treatment outcomes for both >50% (PR+CR+FR)
and >90% (CR+FR) response rate (RR= 3.24, 95%CI 1.89 to 5.57; RR= 20.81, 95%CI 2.97- 145.59,
respectively). While self-administered regimen showed to between treatment group differences for
both >50% (PR+CR+FR) and >90% (CR+FR) response rate analysis (RR= 2.61, 95%CI 0.48 to
14.15; RR= 3.55, 95%CI 0.19- 67.82, respectively). No serious adverse events were noted.
CONCLUSIONS
Neurostimulation may lead to improvement; however, may not render definite complete response.
Office based seems to be better than self-administered therapy. Further RCTs are needed to com-
pare the treatment outcome of the two regimens.