Quality of life and psychological aspects in children with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation - A prospective multicenter study

Published:October 07, 2022DOI:



      To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB).


      This international, multicenter, prospective cohort study involved individuals of 6–16 years of age under TENS treatment for OAB. The study was conducted between June 2016 and December 2019 in four participating centers: two in Australia, one in Germany and one in Brazil. Patients with anatomical and/or neurological abnormalities of the urinary tract were excluded. Questionnaires were applied before and after parasacral TENS treatment: the Dysfunctional Voiding Symptom Score (DVSS), used in Brazil, or the International Consultation on Incontinence Questionnaire - Pediatric Lower Urinary Tract Symptoms (ICIQ-CLUTS), used in Germany and Australia, to analyze urinary symptoms; the Strengths and Difficulties Questionnaire (SDQ) to assess emotional and behavioral aspects; and the Pediatric Incontinence Questionnaire (PinQ) for bladder-specific Qol.


      Fifty-three patients (28 girls and 25 boys) with a mean age of 8.64 ± 2.63 years were included. Median DVSS was 11 (range 6–13.5) and 3 (range 0–7), (p < 0.001), and median ICIQ-CLUTS was 12 (range 9–14) and 9 (range 5.7–12), (p < 0.001), before and after treatment, respectively. Median PinQ score decreased from 47.8 (range 38.9–59.7) to 39 (range 29–53.15) following treatment (p = 0.04). Median total SDQ score before and after treatment was 17 (range 13.5–21) and 15 (range 12–21), respectively (p = 0.939).


      Summary TableComparison of quality of life (PinQ) scores before and after treatment with Parasacral TENS.
      Analyze M (IR) PinQ p∗-value N
      Baseline End of Treatment
      Total sample
      47.8 (38.9–59.7) 39 (29–53.15) 0.04 37
      Questionnaire; M = Median; IR = Interquartile range; N = number of patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dourado E.R.
        • et al.
        Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study.
        J Pediatr Urol. 2019; 15: 376.e1-376.e7
        • Austin P.F.
        • et al.
        The standardization of terminology of lower urinary tract function in children and adolescents: update report from the standardization committee of the international children's continence society.
        J Urol. 2014; 191: 1863-1865.e13
        • Nevéus T.
        • et al.
        The standardization of terminology of lower urinary tract function in children and adolescents: report from the standardisation committee of the international children's continence society.
        J Urol. 2006; 176: 314-324
        • Abrams P.
        • et al.
        The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society.
        Neurourol Urodyn. 2002; 21: 167-178
        • Bower W.F.
        • Sit F.K.Y.
        • Bluyssen N.
        • Wong E.M.C.
        • Yeung C.K.
        PinQ: a valid, reliable and reproducible quality-of-life measure in children with bladder dysfunction.
        J Pediatr Urol. 2006; 2: 185-189
        • Minassian V.A.
        • Lovatsis D.
        • Pascali D.
        • Alarab M.
        • Drutz H.P.
        The effect of childhood dysfunctional voiding on urinary incontinence in adult women.
        Obstet Gynecol. 2006; 107: 47S
        • Nieuwhof-Leppink A.J.
        • et al.
        Definitions, indications and practice of urotherapy in children and adolescents: - a standardization document of the International Children's Continence Society (ICCS).
        J Pediatr Urol. 2021;
        • Hoffmann A.
        • Sampaio C.
        • Nascimento A.A.
        • Veiga M.L.
        • Barroso U.
        Predictors of outcome in children and adolescents with overactive bladder treated with parasacral transcutaneous electrical nerve stimulation.
        J Pediatr Urol. 2018; 14: 54.e1-54.e6
        • Barroso U.
        • et al.
        Nonpharmacological treatment of lower urinary tract dysfunction using biofeedback and transcutaneous electrical stimulation: a pilot study.
        BJU Int. 2006; 98: 166-171
        • Sillén U.
        • et al.
        Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: a randomized controlled trial.
        J Pediatr Urol. 2014; 10: 1100-1105
        • Calado A.A.
        • et al.
        Cross-cultural adaptation of the dysfunctional voiding score symptom (DVSS) questionnaire for Brazilian children.
        Int Braz J Urol. 2010; 36: 458-463
        • de Gennaro M.
        • et al.
        The Iciq-cluts: the first screener questionnaire for lower urinary tract symptoms in children.
        J Pediatr Urol. 2009; 5: S68-S69
        • Goodman R.
        • Meltzer H.
        • Bailey V.
        The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version.
        Int Rev Psychiatr. 2003; 15: 173-177
        • Bower W.F.
        • Wong E.M.C.
        • Yeung C.K.
        Development of a validated quality of life tool specific to children with bladder dysfunction.
        Neurourol Urodyn. 2006; 25: 221-227
        • Lordêlo P.
        • Teles A.
        • Veiga M.L.
        • Correia L.C.
        • Barroso U.
        Transcutaneous electrical nerve stimulation in children with overactive bladder: a randomized clinical trial.
        J Urol. 2010; 184: 683-689
        • Hagstroem S.
        • Mahler B.
        • Madsen B.
        • Djurhuus J.C.
        • Rittig S.
        Transcutaneous electrical nerve stimulation for refractory daytime urinary urge incontinence.
        J Urol. 2009; 182: 2072-2078
        • Quintiliano F.
        • et al.
        Transcutaneous parasacral electrical stimulation vs oxybutynin for the treatment of overactive bladder in children: a randomized clinical trial.
        J Urol. 2015; 193: 1749-1753
        • Equit M.
        • Hill J.
        • Hübner A.
        • Von Gontard A.
        Health-related quality of life and treatment effects on children with functional incontinence, and their parents.
        J Pediatr Urol. 2014; 10: 922-928
        • Clarke M.C.C.
        • et al.
        Decreased colonic transit time after transcutaneous interferential electrical stimulation in children with slow transit constipation.
        J Pediatr Surg. 2009; 44: 408-412
        • Veiga M.L.
        • Lordêlo P.
        • Farias T.
        • Barroso U.
        Evaluation of constipation after parasacral transcutaneous electrical nerve stimulation in children with lower urinary tract dysfunction - a pilot study.
        J Pediatr Urol. 2013; 9: 622-626
        • Glassberg K.I.
        • Combs A.J.
        • Horowitz M.
        Nonneurogenic voiding disorders in children and adolescents: clinical and videourodynamic findings in 4 specific conditions.
        J Urol. 2010; 184: 2123-2127
        • Belsey J.
        • Greenfield S.
        • Candy D.
        • Geraint M.
        Systematic review: impact of constipation on quality of life in adults and children.
        Aliment Pharmacol Ther. 2010; 31: 938-949
        • Fazeli M.S.
        • Pourrahmat M.M.
        • Collet J.P.
        • Afshar K.
        The effects of antimuscarinic agents on the activity of the cardiac autonomic nervous system in children with functional overactive bladder.
        J Pediatr Urol. 2019; 15: 642.e1-642.e6
        • Von Gontard A.
        • Baeyens D.
        • Van Hoecke E.
        • Warzak W.J.
        • Bachmann C.
        Psychological and psychiatric issues in urinary and fecal incontinence.
        J Urol. 2011; 185: 1432-1437
        • Von Gontard A.
        • Lettgen B.
        • Olbing H.
        • Heiken-Löwenau C.
        • Gaebel E.
        • Schmitz I.
        Behavioural problems in children with urge incontinence and voiding postponement: a comparison of a paediatric and child psychiatric sample.
        Br J Urol. 1998; 81: 100-106
        • Bael A.
        • et al.
        Behavior profiles in children with functional urinary incontinence before and after incontinence treatment.
        Pediatrics. 2008; 121: 6-12
        • Von Gontard A.
        • Hussong J.
        • Yang S.
        • Chase J.
        • Franco I.
        • Wright A.
        Neurodevelopmental disorders and incontinence in children and adolescents: Attention-deficit/hyperactivity disorder, autism spectrum disorder, and intellectual disability - A consensus document of the International Children’s Continence Society..
        Neurourol Urodyn. 2021; 41: 104-112
        • von Gontard A.
        • Equit M.
        Comorbidity of ADHD and incontinence in children.
        Eur Child Adolesc Psychiatr. 2015; 24: 127-140
        • Achenbach T.M.
        • McConaughy S.H.
        • Howell C.T.
        Child/adolescent behavioral and emotional problems: Implications of cross-Informant correlations for situational specificity.
        Psychol Bull. 1987; 101: 213-232
        • Becker A.
        • Hagenberg N.
        • Roessner V.
        • Woerner W.
        • Rothenberger A.
        Evaluation of the self-reported SDQ in a clinical setting: do self-reports tell us more than ratings by adult informants?.
        Eur. Child Adolesc. Psychiatry, Suppl. 2004; 13: 17-24