Estudo comparativo entre a eletroestimulação transcutânea do nervo tibial posterior e a transcutânea parassacral no tratamento da Síndrome da Bexiga Hiperativa em mulheres idosas

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, 2019.A eletroestimulação de superfície tem sido usada no tratamento da Síndrome da bexiga hiperativa. O objetivo do estudo é comparar o efeito da eletroestimulação transcutânea do nervo tibial posterior e da eletroestimulação transcutânea parassacral no tratamento da Síndrome da bexiga hiperativa em idosas. Mulheres idosas diagnosticadas com Síndrome da bexiga hiperativa foram randomizadas em dois grupos de acordo com o tipo eletroestimulação transcutânea: eletroestimulação transcutânea do nervo tibial posterior (G1), transcutânea parassaral (G2).Todas as participantes receberam eletroestimulação (DUALPEX 961 â - marca Quark) de acordo com a locação do grupo, duas vezes por semana, por 30 minutos à baixa frequência (10Hz) por 8 sessões. Todas as pacientes receberam uroterapia. Como avaliação primária foi considerado o questionário de qualidade de vida (ICIQ-SF) e questionário de sintomas miccionais (ICIQ-OAB). Os desfechos secundários foram o diário miccional de 3 dias e o teste do absorvente de 1 hora. Ambos os tratamentos são eficazes na melhora dos sintomas pelos questionários ICIQ-SF (G1 = <0.001; G2 = <0.001) e ICIQ-OAB (G1 = <0.001; G2 = <0.001). No diário de 3 dias, o G1 reduziu o número de noctúria (p<0.001), urgência miccional (p<0.001), e urge-incontinência (p<0.001). Enquanto que no G2 houve diminuição no número de episódios de noctúria (p<0.001). Não houve diferença entre os grupos (p=0,668) no teste do absorvente. Não houve diferença significativa entre os grupos, ambos os tratamentos propostos são eficazes na melhora da Síndrome da Bexiga Hiperativa em idosas. Porém, o grupo de eletroestimulação transcutânea do nervo tibial posterior apresentou melhora em mais variáveis comparado ao grupo de eletroestimulação parassacral.Surface electrostimulation has been used to treat overactive bladder syndrome. The aim of the study is to compare the effect of transcutaneous posterior tibial nerve electrostimulation and parasacral transcutaneous electrostimulation in the treatment of overactive bladder syndrome in the elderly. Elderly women diagnosed with overactive bladder syndrome were randomized into two groups according to the type of transcutaneous electrostimulation: transcutaneous posterior tibial nerve (G1) electrostimulation, parasaral transcutaneous (G2). All participants received electrostimulation (DUALPEX 961 â - Quark brand) according to group location twice a week for 30 minutes at low frequency (10Hz) for 8 sessions. All patients received urotherapy. The primary evaluation was the quality of life questionnaire (ICIQ-SF) and voiding symptoms questionnaire (ICIQ-OAB). Secondary outcomes were the 3-day voiding diary and the 1-hour pad test. Both treatments are effective in improving symptoms by the ICIQ-SF (G1 = <0.001; G2 = <0.001) and ICIQ-OAB (G1 = <0.001; G2 = <0.001) questionnaires. In the 3-day diary, G1 reduced the number of nocturia (p <0.001), urinary urgency (p <0.001), and urge incontinence (p <0.001). While in G2 there was a decrease in the number of nocturia episodes (p <0.001). There was no difference between groups (p = 0.668) in the absorbent test. There was no significant difference between the groups, both proposed treatments are effective in improving Hyperactive Bladder Syndrome in the elderly. However, the transcutaneous posterior tibial nerve electrostimulation group showed improvement in more variables compared to the parasacral electrostimulation group

Investigation of transcutaneous electrical nerve stimulation with a specific focus on the treatment of overactive bladder

This thesis investigates transcutaneous electrical nerve stimulation (TENS), and in particular its role in the treatment of overactive bladder (OAB), which has been of interest for several decades. A standardization and an evaluation of various TENS parameters of stimuli would be beneficial to optimize the techniques used and to achieve the maximal effectiveness. Previously, Hoffman reflex (H reflex) inhibition was interpreted as a surrogate measure of bladder afferent nerve activity, and thus showed a potential to be useful for such evaluations. However, an influence of other factors, such as pelvic floor muscle contraction on this H reflex inhibition makes this surrogate measure unsuitable. In general TENS techniques are usually implemented in the patient’s treatment pathway as secondary treatment options. This is presumably due to a lack of effectiveness. Therefore a thought was given to enhance the effectiveness of the stimuli by producing a larger sensory input with a spatial temporal pattern. This lead to a development of a novel ‘Sensory Barrage Stimulation’, as introduced in this thesis. The technique showed promising effectiveness in comparison to a conventional type of TENS in the patients with elbow spasticity. Other researcher groups have tried to enhance the effectiveness by stimulating deep nerve structures (usually only targetable by implanted devices) using non/invasive transcutaneous stimulation and a specific waveform. However the “Transdermal Amplitude Modulated Signal” waveform introduced for the treatment of OAB symptoms, which claimed to pass through the skin more easily did not appear to be any different to a conventional stimuli and thus it is not of benefit for the routine clinical practice. Specifically, on the treatment for OAB syndrome symptoms, the most promising seems to be the Posterior Tibial Nerve Stimulation (PTNS) applied near the ankle. A well-established form of PTNS, which uses a needle to stimulate the nerve have disadvantages of being invasive and expensive due to the patient’s clinical sessions. The transcutaneous form of PTNS was investigated here in a home based randomized pilot trial of idiopathic overactive bladder patients. A promising effect indicates that there might be patients who can benefit from this type of non-invasive and low cost approach of PTNS. Additionally a numerical modelling of both types of PTNS showed that both techniques achieve a stimulation comparable in a way of physiological effects. Thus suggesting the evidence of percutaneous form of PTNS is plausible to be present in the transcutaneous form