Feasibility and Efficacy of Transdermal Hypogastric Nerve Stimulation in Treatment of Overactive Bladder in Multiple Sclerosis: A Prospective Randomized Controlled Trial

Objective: To determine the feasibility and efficacy of transdermal hypogastric nerve stimulation by interferential current stimulation (IFCs) in the treatment of OABs in relapsing-remitting multiple sclerosis (RRMS). Material and Methods: Forty male RRMS patients with moderate overactive bladder symptoms were randomly assigned into two equal groups; the control group (G1) was treated with selected therapeutic exercises for strengthening the pelvic floor muscles, and the intervention group (G2) received the same regimen plus hypogastric nerve stimulation at T10-L2 by interferential current (IFC). In both groups, the duration of each session ranged from 40-45 minutes, three days weekly for a month. Pre and post treatment evaluation was done by Overactive bladder symptom score (OABSS) included (daytime frequency, nocturia, urgency, and urgency incontinence) and Urodynamics tests included (bladder capacity, maximum flow rate, bladder compliance, detrusor instability) and post voiding residual urine measurement by abdominal ultrasound. The effect of treatment on bladder capacity, maximum flow rate, post void residual, bladder compliance and OVBSS was investigated using a mixed MANOVA. The Mann Whitney test was used to evaluate the detrusor instability between groups, and the Wilcoxon signed ranks test was used to compare pre and post treatment in each group. The level of significance was set at p < 0.05 for all statistical tests. Results: Showed that a significant increase in bladder capacity, bladder compliance, percentage of detrusor stability and maximal flow rate and a significant decrease in post void residual post treatment in comparison with pretreatment (p < 0.05) in both groups. There was a significant decrease in the daytime and nighttime frequency and urgency post treatment compared with that pretreatment in both groups (p > 0.001) while a significant decrease of urgency incontinence in the study group only post treatment compared with that pretreatment (p > 0.001). Post treatment, there was a significant difference of the intervention group (G2) compared with that of the control group (G1) for all tested variables (P< 0.05) except for the daytime frequency and percentage of detrusor stability (p > 0.05). Conclusions: Transdermal hypogastric nerve stimulation using IFC could be considered a feasible treatment option for neurogenic OABs in multiple sclerosis patients.