To assess the efficacy and safety of neurostimulation for non-neurogenic OAB in children we conducted a meta-analysis of randomized controlled trials (RCTs).
A systematic literature search was done on August 2016. RCTs were evaluated according to the Cochrane Collaboration risk of bias assessment. Number of patients with post-treatment partial response/PR (50%-89%), complete response/CR (≥90%) and full response/FR (100%) were extracted for relative risk (RR) and 95% CI. Effect estimates were pooled using the Mantel-Haenszel method with random effect model if significant inter-study heterogeneity (p<0.1) was noted. Subgroup analysis was done according to each treatment setting. (PROSPERO CRD42016043502).
Five eligible studies (245 patients) were included. Overall effect estimates showed that compared to standard urotherapy, neurostimulation demonstrated significantly better >50% (PR+CR+FR) response (RR= 2.8, 95%CI 1.1-7.2), but not >90% (CR+FR) response (RR=8.28, 95%CI 0.65- 105.92). Clinic based neurostimulation had significantly better treatment outcomes for both >50% (PR+CR+FR) and >90% (CR+FR) responses (RR= 3.24, 95%CI 1.89 to 5.57; RR= 20.81, 95%CI 2.97- 145.59, respectively), while a self-administered regimen showed no differences for both >50% (PR+CR+FR) and >90% (CR+FR) response rates between treatment groups (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 reported.
Neurostimulation therapy may lead to better partial improvement of non-neurogenic OAB; however, may not render a definitive complete response. Office based neurostimulation seems more efficacious than self-administered. Further RCTs are needed to compare outcomes of the two regimens.
Urology. 2017 Aug 17 [Epub ahead of print]
Nicolas Fernandez, Michael E Chua, Jessica M Ming, Jan Michael Silangcruz, Fadi Zu'bi, Joana Dos Santos, Armando J Lorenzo, Luis H Braga, Roberto Iglesias Lopes
Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada. Electronic address: ., Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada., St. Luke's Medical Center, Quezon City, Philippines., Rambam Health Care Campus, Haifa, Israel., McMaster Children's Hospital, McMaster University, Hamilton, Canada., Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada; Division of Urology, University of Sao Paulo, Brazil.