Parasacral Transcutaneous Electrical Nerve Stimulation (TENS) in Pediatric Bladder Dysfunction

Urinary incontinence, constipation, and recurrent urinary tract infections are common problems in children and constitute upwards of 40% of all pediatric urology office visits. Common treatment for these issues includes timed toileting, anticholinergics, management of constipation with dietary measures or medications, pelvic floor physical therapy, biofeedback and, at times, surgical intervention. Most of these children will demonstrate improvement in their bowel and bladder dysfunction and a decrease in the number of urinary tract infections (UTIs) with these interventions. However, in some children, alternative therapies may be indicated. One of these alternative therapies is parasacral transcutaneous electrical nerve stimulation (PTENS). Although the exact mechanism of action of PTENS remains elusive, multiple studies have shown this to be a successful treatment, which can be used in the treatment of bladder overactivity, constipation, dysfunctional voiding, and nocturnal enuresis in children. In this chapter, we review normal bladder neuroanatomy and physiology, PTENS technique and its theorized mechanism of action, as well as the indications, treatment outcomes, and side effects of PTENS in children.