야뇨증 소아에서 방광내 전기자극요법의 경험

Abstract

Purpose: We investigated the therapeutic effect of intravesical electrical stimulation (IVES) in enuretic children who showed refractory response to drug therapy, on the basis that IVES induces direct activation of bladder Aδ mechanoreceptor afferents which would result in modulation of a central micturition reflex. Materials and Methods: Of 351 enuretic children, the 22 who showed refractory response to drug monotherapy or combination therapy were enrolled in a clinical trial with IVES and then the therapeutic results of IVES and Post-IVES additional drug therapy were evaluated. Therapeutic response was defined when the frequency of bed-wetting was reduced by more than 50%.Results: The rates of therapeutic response to IVES and Post-IVES additional drug therapy were 63.6% and 89.5%, respectively. As compared with Pre-IVES drug therapy, IVES and Post-IVES additional drug therapy showed significant therapeutic effect (p＜0.05). Factors such as sex, depth of sleep, attention insufficiency, family history, voiding pattern, frequency of IVES procedure, fecal symptoms and day-time voiding symptoms had no significant impact on therapeutic response to IVES in enuresis (p＞0.05). However, there was significant reduction of bed-wetting after IVES in cases with improved day-time voiding symptoms after IVES (p=0.031). Conclusions: In either a case of enuresis which shows refractory response to drug therapy as a primary modality of treatment or a case of complicated enuresis, IVES and Post-IVES additional drug therapy may produce a therapeutic response.