Eletroestimulação nervosa transcutânea parassacral combinada ao acetato de desmopressina no tratamento da enurese monossintomática primária: ensaio clínico, randomizado, cego e placebo controlado

Abstract

Introduction: According to the International Children's Continence Society - ICCS, enuresis is the involuntary loss of urine during sleep in children over 5 years of age. It is classified as monosymptomatic in the absence of lower urinary tract symptoms and as primary when there no periods of continence exceeding six months. Drug treatment with desmopressin acetate is well-established, but many patients do not respond adequately or experience relapses after its withdrawal. Transcutaneous parasacral nerve electrical stimulation is widely used in the treatment of lower urinary tract disorders and has recently shown good results in monosymptomatic enuresis. The association of different treatment modalities is a trend, but there is no study that evaluated the association of desmopressin and electrotherapy. Objective: To evaluate whether the association of desmopressin acetate with transcutaneous parasacral nerve electrical stimulation is more effective than treatment with desmopressin alone in children and adolescents with primary monosymptomatic enuresis. Methods: Prospective, controlled, and randomized study, involving children and adolescents between six and 17 years, 11 months and 29 days diagnosed with monosymptomatic enuresis. Participants were divided into a placebo group (desmopressin and placebo electrical stimulation) and an intervention group (desmopressin and electrical stimulation). Both groups performed 15 electrotherapy sessions, once a week, for 30 minutes, frequency parameters of 10 HZ, pulse width of 700 µs and intensity determined by the patient. The response was assessed at the end of the intervention and 6 months after the end of treatment using the dry nights calendar. Results: Of the 66 participants, 34 belonged to the intervention group and 32 to the placebo group. The median age was 10.3 years and 53.0% were male. The intention-to-treat analysis found a significant reduction in the frequency of wet nights (p<0.001) in both groups. However, the intervention group showed a significant improvement immediately after treatment with a 59.4% reduction in the frequency of wet nights (p=0.005) compared to the placebo group, with a 21.5% reduction. Six months after the end of treatment, only the intervention group continued to improve, with a 65.5% reduction in wet nights (p<0.001). The Kaplan-Meier survival analysis showed that the improvement in the intervention group became more pronounced from the 16th week onwards (log-rank test, p=0.01). Conclusion: Parasacral transcutaneous electrical nerve stimulation combined with desmopressin in the treatment of primary monosymptomatic enuresis significantly reduced wet nights in the short and long term.