Cheng Fangzheng,Wang Dongming,Zhang Yunhe,et al.The predictive value of early symptom changes during TTNS treatment for 24 week delayed response in pediatric patients with chronic obstructive pulmonary disease (OAB)[J].Journal of Clinical Pediatric Surgery,,():632-636.[doi:10.3760/cma.j.cn101785-20260309-00099]
The predictive value of early symptom changes during TTNS treatment for 24 week delayed response in pediatric patients with chronic obstructive pulmonary disease (OAB)
- Keywords:
- Overactive Bladder; Transcutaneous Electrical Nerve Stimulation; Tibial Nerve; Child; Treatment Outcome
- Abstract:
- Objective To investigate the predictive value of early symptom changes at 12 weeks for delayed response at 24 weeks in children with overactive bladder (OAB) receiving transcutaneous tibial nerve stimulation (TTNS),and to provide evidence for treatment-course decision-making. Methods A secondary analysis was performed based on data from a prospective single-arm cohort of extended-course TTNS in the Department of Pediatric Surgery,Qilu Hospital of Shandong University.Eighty children with OAB who received 24 weeks of TTNS treatment and completed paired follow-up assessments were included.The Overactive Bladder Symptom Score (OABSS) and Pediatric Quality of Life Inventory (PedsQL) were used for assessment before treatment and at 12 and 24 weeks of treatment,respectively.Clinical response was defined as a decrease of ≥3 points in OABSS from baseline.According to the response status at 12 and 24 weeks of treatment,the children were divided into early sustained responders (ESR),late responders (LR),and persistent non-responders (PNR).Baseline characteristics and early changes at 12 weeks were compared among the three groups,and receiver operating characteristic curves were used to evaluate predictive performance.Results Among the 80 children,53 (66.25%) were classified as ESR,14 (17.50%) as LR,and 13 (16.25%) as PNR.There were no statistically significant differences in baseline characteristics among the three groups (P>0.05).Multivariable logistic regression showed that age,sex,body mass index,disease duration,baseline OABSS,and baseline PedsQL score could not independently predict the occurrence of PNR (P>0.05).Among the 27 children who did not achieve clinical response at 12 weeks,the decrease in total OABSS at 12 weeks was greater in the LR group than in the PNR group[2.00 (1.00,2.00) points vs.1.00 (0.00,1.00) points,P=0.005],and the increase in total PedsQL score was also greater in the LR group than in the PNR group[8.70 (3.53,10.87) points vs.2.17 (1.09,8.70) points,P=0.039].Subsymptom analysis showed that improvement in urgency urinary incontinence was more pronounced in the LR group than in the PNR group (P=0.008).The area under the curve for the 12-week decrease in OABSS for predicting delayed response at 24 weeks was 0.799.The optimal cut-off value was a decrease of ≥2 points,with a sensitivity of 64.3%,specificity of 92.3%,and positive predictive value of 90.0%.Conclusion The long-term efficacy of TTNS in children with OAB is difficult to accurately predict using pretreatment baseline characteristics.Early improvement at 12 weeks,especially an OABSS decrease of ≥2 points and relief of urgency urinary incontinence,may help identify children suitable for extended treatment.
References:
[1] Austin PF,Bauer SB,Bower W,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].J Urol,2014,191(6):1863-1865.e13.DOI:10.1016/j.juro.2014.01.110.
[2] Franco I.Overactive bladder in children[J].Nat Rev Urol,2016,13(9):520-532.DOI:10.1038/nrurol.2016.152.
[3] 张晔,张殷,蒋加斌,等.小剂量索利那新治疗儿童特发性膀胱过度活动症的短期疗效与安全性分析[J].临床小儿外科杂志,2023,22(2):134-138.DOI:10.3760/cma.j.cn101785-202210053-007. Zhang Y,Zhang Y,Jiang JB,et al.Short-term efficacy and safety of low-dose solifenacin for newly diagnosed idiopathic overactive bladder in children[J].J Clin Ped Sur,2023,22(2):134-138.DOI:10.3760/cma.j.cn101785-202210053-007.
[4] Cheng Z,Chai Y,Zhou Z,et al.The efficacy of parasacral transcutaneous electrical nerve stimulation for the treatment of overactive bladder in children:a systematic review and meta-analysis[J].Front Pediatr,2025,13:1450634.DOI:10.3389/fped.2025.1450634.
[5] Cheng FZ,Wang J,Wang DM,et al.Extended-course transcutaneous tibial nerve stimulation for pediatric overactive bladder:a 6-month prospective single-arm study[J].World J Urol,2026,44(1):218.DOI:10.1007/s00345-026-06249-9.
[6] Homma Y,Yoshida M,Seki N,et al.Symptom assessment tool for overactive bladder syndrome-overactive bladder symptom score[J].Urology,2006,68(2):318-323.DOI:10.1016/j.urology.2006.02.042.
[7] Varni JW,Seid M,Kurtin PS.PedsQL 4.0:reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations[J].Med Care,2001,39(8):800-812.DOI:10.1097/00005650-200108000-00006.
[8] Gotoh M,Homma Y,Yokoyama O,et al.Responsiveness and minimal clinically important change in overactive bladder symptom score[J].Urology,2011,78(4):768-773.DOI:10.1016/j.urology.2011.06.020.
[9] Jaeschke R,Singer J,Guyatt GH.Measurement of health status.Ascertaining the minimal clinically important difference[J].Control Clin Trials,1989,10(4):407-415.DOI:10.1016/0197-2456(89)90005-6.
[10] Arunaa S,Babu R,Madhu R,et al.Systematic review and meta-analysis on the role of transcutaneous electrical nerve stimulation in children with overactive bladder-pooled analysis of nine randomized controlled trials[J].J Pediatr Urol,2026,22(1):105606.DOI:10.1016/j.jpurol.2025.09.012.
[11] Sayner AM,Rogers F,Tran J,et al.Transcutaneous tibial nerve stimulation in the management of overactive bladder:a scoping review[J].Neuromodulation,2022,25(8):1086-1096.DOI:10.1016/j.neurom.2022.04.034.
[12] Sillén U,Arwidsson C,Doroszkiewicz M,et al.Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children:a randomized controlled trial[J].J Pediatr Urol,2014,10(6):1100-1105.DOI:10.1016/j.jpurol.2014.03.017.
[13] Patidar N,Mittal V,Kumar M,et al.Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder:a preliminary report[J].J Pediatr Urol,2015,11(6):351e1-e6.DOI:10.1016/j.jpurol.2015.04.040.
[14] Lee UJ,Macdiarmid S,Matthews CA,et al.Tibial nerve stimulation for urge urinary incontinence and overactive bladder:narrative review of randomized controlled trials and applicability to implantable devices[J].Adv Ther,2024,41(7):2635-2654.DOI:10.1007/s12325-024-02864-3.
[15] Al-Danakh A,Safi M,Alradhi M,et al.Posterior tibial nerve stimulation for overactive bladder:mechanism,classification,and management outlines[J].Parkinsons Dis,2022,2022:2700227.DOI:10.1155/2022/2700227.
[16] De groat WC,Tai CF.Impact of bioelectronic medicine on the neural regulation of pelvic visceral function[J].Bioelectron Med,2015,2015:25-36.DOI:10.15424/bioelectronmed.2015.00003.
Memo
收稿日期:2026-3-9。
基金项目:山东省自然科学基金面上项目(ZR2022MH276)
通讯作者:王健,Email:wjdoctor2021@126.com