İşeme Disfonksiyonu Olan Çocuk Hastalarda Transkütanöz Posterior Tibial Sinir Stimülasyonunun Etkinliği
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Non-pharmacological, pharmacological and invasive treatment methods are used for the treatment of children with voiding dysfunction and non-invasive and invasive methods are used in the diagnosis and follow-up of these patients. At the same time, the search for new diagnostic, treatment and follow-up methods continues. Percutaneous posterior tibial nerve stimulation (PPTNS) is one of the recommended treatment modalities in these patients. There are few studies in the literature to show the role of urine biomarkers in diagnosis and follow-up. Few studies have shown the potential benefits of NGF (nerve growth factor), TGF-beta 1 (transforming growth factor-beta 1), TIMP-2 (tissue inhibitor of metalloproteinases 2). Thus a prospective randomized, controlled study was planned to demonstrate the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS), which is a less invasive and therefore more tolerable method and to assess the role of urinary biomarkers (NGF, TGF-beta 1, TIMP-2) in the diagnosis and follow-up of children with voiding dysfunction. For this purpose, children between 6-15 years old who stopped treatment due to side effects and who were resistant to medical treatment between 01.2018-09.2018 were included to our study. Patients were divided into two goups; test (N=20) and sham (N=10) group by closed envelope method. TPTNS therapy was applied to the test group for 12 weeks, in 30 minute sessions once a week by stimulation given at certain dose intervals. The same procedure was applied to the sham group without any stimulation. Urine biomarkers, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, urodynamic or uroflowmetry tests were applied to both groups before and after treatment. In addition, to 14 healthy children without urinary complaints DVISS scores and urine biomarkers were evaluated for control group. In the test group, the frequency of urgency after treatment (p < 0.001), daytime incontinence episodes (p < 0.006), general DVISS scores (p < 0.001), daytime DVISS scores (p < 0.001) and quality of life score (p = 0.019) were significantly decreased. There were also significant decreases in general DVISS scores (p = 0.007), daytime DVISS scores (p = 0.005) and quality of life scores (p = 0.040) in the sham group. There was no difference between NGF (p = 0.199), TGF-beta 1 (p = 0.480), and TIMP-2 (p = 0.940) levels of patient and healthy volunteers group before treatment. Neither the NGF, TGF-beta 1, TIMP-2 levels in the test group (p = 0.250; 0.850; 0.460, respectively) nor the NGF, TGF-beta 1, TIMP-2 levels in the sham group (p = 0.580; 0.580; 0.650, respectively) changed significantly with the treatment. In our study, it was observed that TPTNS treatment provides significant improvement in some parameters of pediatric patients with voiding dysfunction. These findings support that TPTNS has a role in the treatment of pediatric patient group who does not respond to standard medical treatment. The benefit of TPTNS to the aforementioned patient group is observed especially in daytime symptoms. Further studies with greater number of patients are needed on this issue. According to our findings, urine biomarkers (NGF, TGF-beta1, TIMP-2) are not useful for diagnosis and follow-up of these patients.