Dados do Trabalho

Título

EFFECTIVENESS OF NON-INVASIVE ELECTRO-STIMULATION IN THE TREATMENT OF URINARY AND FAECAL SYMPTOMS IN CHILDREN AND ADOLESCENTS WITH SPINA BIFIDA

Resumo

Introduction: Intestinal and urinary dysfunction with a neurogenic basis is characterized by a loss of voluntary control over urine and feces, leading to constipation and the presence of urinary symptoms due to neurogenic bladder in children and adolescents who are refractory to initial conservative treatment. Neuromodulation has been used, as a therapeutic modality that stimulates nerve fibers, which returns to efficient target organs. Although this treatment shows promising results but is necessary to carry out a systematic review on this subject. Objectives: To evaluate the effectiveness of non-invasive neuromodulation in improving intestinal and urinary symptoms in children and adolescents with spina bifida. Methods: A systematic review of randomized clinical trials was carried out by searching PubMed databases, Physiotherapy Evidence Database, ScienceDirect, Virtual Health Library and EMBASE. Methodological quality was assessed using the Risk of bias tools scale. Results: Four randomized clinical trials were included. Regarding urinary outcomes, in the intergroup analysis, in one study, the urinary incontinence score, number of diapers per day and pressure at the detrusor leak point showed improvement with the use of neuromodulation in relation to the control group with (p=0.02), (p=0.03) and (p=0.03) respectively. Another study also showed a degree of improvement through electrostimulation regarding the urinary incontinence score (p=0.01). That same article reported the benefit of using this treatment through the analysis of post-void residue (p=0.02) and detrusor sphincter dyssynergy (p=0.05). Regarding fecal outcomes, an article showed that there was an improvement with treatment in the number of defecations (p=0.01), pain during defecation (p=0.01), anorectal sphincter pressure (p=0.04) and finally, on the neurogenic bowel dysfunction score (p=0.01). Conclusion: Although this systematic review has shown an improvement in urinary and intestinal symptoms with the use of non-invasive Electrostimulation, the heterogeneity of the studies does not allow us to affirm the real effectiveness of this treatment modality.

Palavras Chave

Children; Spina Bifida; Neuromodulation