TENS in Nocturnal Enuresis

Maintenance Parasacral Electrical Nerve Stimulation Versus Observation After Initial Response in Children With Primary Nocturnal Enuresis: A Randomized Controlled Trial

Paracascral transcutaneous electrical nerve stimulation (PTENS) is a credible therapeutic option for nocturnal enuresis. The investigators shall investigate whether maintenance PTENS after initial response improves durability of remission compared with observation alone.

Inclusion Criteria:

• Diagnosis of primary monosymptomatic nocturnal enuresis (PMNE) based on International Children's Continence Society (ICCS) criteria.
• Persistent symptoms after at least 8 weeks of standardized urotherapy, including counseling on timed voiding, evening fluid management, and bowel optimization.
• Baseline severity of ≥3 wet nights per week on a 14-night diary.
• Ability of the child and caregiver to complete diaries and comply with home treatment and follow-up.

Exclusion Criteria:

• Non-monosymptomatic enuresis, daytime urgency, daytime incontinence, dysfunctional voiding, or significant post-void residual.
• Neurogenic bladder, spinal dysraphism, cerebral palsy, epilepsy uncontrolled on treatment, or other neurologic diseases affecting lower urinary tract function.
• Congenital or acquired urinary tract abnormalities.
• Active urinary tract infection.
• Untreated or refractory constipation at enrollment.
• Implanted electrical devices, significant dermatologic lesions at electrode sites, or other contraindications to electrical stimulation.
• Cognitive, behavioral, or social circumstances preventing adherence.