human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Transcutaneous electrical stimulation ( TES ) speeds up colonic transit in children with slow-transit constipation ( STC ) . This study examined if concurrent upper gastrointestinal dysmotility ( UGD ) affected response to TES . Methods  Radio-nuclear transit studies ( NTS ) were performed before and after TES treatment of STC as part of a larger r and omised controlled trial . UGD was defined as delayed gastric emptying and /or slow small bowel transit . Improvement was defined as increase of ≥1 Geometric Centre ( median radiotracer position at each time [ small bowel = 1 , toilet = 6 ] ) . Results Forty-six subjects completed the trial , 34 had NTS after stimulation ( 21 M , 8–17 years , mean 11.3 years ; symptoms > 9 years ) . Active stimulation increased transit in > 50 % versus only 25 % with sham ( p = 0.04 ) . Seventeen children also had UGD  . In children with STC and either normal upper GI motility ( NUGM ) and UGD , NTS improved slightly after 1 month ( 57 vs. 60 % ; p = 0.9 ) and more after 2 months ( 88 vs. 40 % ; p = 0.07 ) . However , mean transit rate significantly increased with NUGM , but not UGD ( 5.0 ± 0.2 : 3.6 ± 0.6 , p < 0.01 ) . Conclusion Transcutaneous electrical stimulation was beneficial for STC , with response weakly associated with UGD . As measured by NTS , STC children with NUGM responded slightly more , but with significantly greater increased transit compared to those with UGD . Higher numbers are needed to determine if the difference is important PURPOSE We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children . We design ed a prospect i ve r and omized trial with sham control for this evaluation . MATERIAL S AND METHODS We prospect ively r and omized 25 girls and 12 boys with an average age of 7.6 years ( range 4 to 12 ) into the test ( active treatment ) or sham ( superficial scapular electrical stimulation ) group . A total of 20 sessions , 20 minutes each ( 10 Hz ) were performed 3 times weekly . The criteria used to evaluate the rate of success were 1 ) self-reported cure , or significant , mild or no improvement ; 2 ) visual analogue scale ( level of success 0 to 10 ) ; 3 ) percent improvement ; 4 ) modified Toronto score ; and 5 ) maximum voided volume , average voided volume and number of voids daily based on bladder diary entries . After completion of the 20 sessions controls who were not cured underwent active treatment . RESULTS A total of 21 patients in the test group and 16 in the sham group underwent treatment . Among the active treatment group 61.9 % of parents reported cure . In the sham group no parent reported cure ( p < 0.001 ) . Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group , while 1 parent in the sham group indicated a score of 9 ( p = 0.002 ) . Additionally 100 % improvement was reported by 12 parents in the test group and no parent in the sham group . Toronto score improved significantly in the test group ( p < 0.001 ) and sham group ( p = 0.008 ) . However , the score was reduced more significantly in the test group compared to the sham group ( p = 0.011 ) . In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased . After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured . CONCLUSIONS This is the first known r and omized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder BACKGROUND The aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation ( TENS ) treatment improves the results of st and ard urotherapy in children with overactive bladder ( OAB ) symptoms . MATERIAL AND METHODS Sixty-two children with symptoms of OAB and incontinence were included . The children were r and omized either to st and ard urotherapy treatment alone or a combination of st and ard urotherapy and TENS . The effect variables were taken from a voiding-drinking diary : number of voiding , number of incontinence episodes , and maximum voided volume . RESULTS Both treatment groups had good treatment results , with no significant difference between the groups . In the st and ard treatment group 13/28 ( 46 % ) were completely dry and 11/28 ( 40 % ) had a decrease in incontinence episodes , compared to 16/24 ( 67 % ) and 3/24 ( 13 % ) , respectively , in the st and ard+TENS group ( p=0.303 ) . The number of voiding decreased in two-thirds of the patients in both groups . However , maximal voided volume only increased in the st and ard treatment group . Subjectively 72 % and 80 % considered themselves significantly improved or free of symptoms . Previous treatment was registered in 15/55 ( 27 % ) . All efficacy variables decreased in those with previous treatment , but with no difference between the st and ard and st and ard+TENS treatment groups . The only difference noted was when comparing the children without previous treatment in the groups : a significantly higher proportion were completely dry in the TENS group ( 12/18 [ 71 % ] versus 10/22 [ 48 % ] , p=0.05 ) . CONCLUSION Our results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy+TENS , whereas a tendency to difference was found in children without previous treatment . Thus with good urotherapy support , TENS only seems to have marginal additional effects on OAB symptoms INTRODUCTION Overactive bladder ( OAB ) is the most prevalent voiding disorder in childhood , and its main manifestation is urinary urgency . In general , urotherapy and anticholinergics are the first choices of treatment . Parasacral Transcutaneous Electrical Neural Stimulation ( PTENS ) was introduced as an alternative for the treatment of detrusor overactivity in children , but treatment protocol s described to date require several sessions per week or long-lasting sessions , making it difficult for the child to adhere to the treatment . Thus , this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children . STUDY DESIGN This prospect i ve , r and omized controlled trial included 16 children with OAB . Children were divided into two groups : CG ( urotherapy and electrical stimulation placebo ) and EG ( urotherapy and PTENS ) . For both groups , therapy was delivered in 20 weekly sessions , of duration 20 min each . Placebo electrical stimulation was done in the scapular area . The children were evaluated prior to treatment ( T1 ) , at the end of the 20 sessions ( T2 ) , and 60 days after the completion of treatment ( T3 ) , with a 3-day voiding diary , visual analogue scale ( VAS ) , Rome III diagnostic criteria , and the Bristol Scale . RESULTS The groups were similar in age , gender , and ethnicity . In the initial assessment , all children , in both groups , had urgency and incontinence , 50 % in each group had constipation , and enuresis was present in seven children ( 87.5 % ) in the EG and six ( 75 % ) in the CG . No differences were found between the groups regarding the volumetric measurements made in the voiding diary , urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale . Sixty days after treatment , a significant improvement was found in the EG group ( p = 0.03 ) regarding urgency ( Table ) , as well as an increase in dry nights in those presenting with enuresis ( p = 0.03 ) . No difference was noted regarding urinary incontinence ( Table ) . At the end of 20 sessions and after 60 days of treatment , those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS ( p = 0.05 and 0.04 , respectively ) . CONCLUSIONS Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis , and in the perception of those responsible for the children . Further studies with larger population s are needed to corroborate these results BACKGROUND Until now no confirmatory clinical trial in children suffering from nonneurogenic overactive bladder ( OAB ) and urinary incontinence could demonstrate superiority for antimuscarinics over placebo . OBJECTIVES The following study was conducted to prove efficacy and tolerability of propiverine compared to placebo . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blind , placebo-controlled phase 3 trial with parallel-group design in children aged 5 - 10 yr was performed . Prior to the 8-wk medical therapy urologic baseline diagnostics , a 3-wk lifestyle advice ( urotherapy ) was established . INTERVENTION After re-evaluation of in- and exclusion criteria and uroflowmetry , only children fulfilling the requested criteria were allocated to a body-weight-adjusted therapy ( 10 or 15 mg propiverine twice daily or corresponding placebo ) . MEASUREMENTS Efficacy parameters derived from bladder diary and a micturition volume protocol . Decrease in voiding frequency per day was chosen as primary efficacy parameter ; secondary endpoints included voided volume and incontinence episodes . A safety assessment was conducted . RESULTS AND LIMITATIONS Of 171 r and omized children , 87 were treated with propiverine and 84 with placebo .  The primary efficacy parameter showed a decrease in voiding frequency ( -2.0 episodes for propiverine versus -1.2 for placebo ; p=0.0007 ) . Superiority could also be demonstrated for voided volume ( 31.4 vs. 5.1 ml ; p<0.0001 ) and incontinence episodes ( -0.5 vs. -0.2 episodes per d ; p=0.0005 ) . The trial design did not allow for separate evaluation of the effect of urotherapy prior to medical treatment . Propiverine was well-tolerated in children . Altogether 23 % of side-effects were reported for propiverine and 20 % for placebo . CONCLUSIONS This clinical trial showed superior efficacy of propiverine over placebo and good tolerability for the treatment of children suffering from OAB and urinary incontinence . An important additional factor for the success of the trial was a modified trial design with previous urotherapy . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00603343 PURPOSE Transcutaneous electrical stimulation ( TES ) ( 3 sessions/wk ) over the abdomen stimulated bowel functions in a r and omized controlled trial . This pilot study assessed whether daily TES at home with a safe , portable machine would be possible and more efficacious than trial results . METHODS Eleven patients ( 6 male/5 female ; mean age , 14 years ; range , 12 - 18 years ) with slow-transit constipation who relapsed or responded poorly in the trial were recruited ( 11 + /- 5 months later ) . An EPM-IF-4160 ( Fuji Dynamics , Hong Kong ) portable machine ( sine waveform , 4 kHz carrier frequency , 80 - 160 Hz beat frequency , intensity <33 mA ) delivering interferential current ( 2 electrodes over epigastrium + 2 over kidneys ) was applied 1 hour daily at home . Continence diaries were kept for 1 month before and 2 months during treatment . RESULTS All children completed more than 1 month of treatment after baseline recording . Defecation increased in 9 of 11 children , and soiling decreased in 4 of 11 children . There was a significant increase in total episodes of defecation per week ( mean + /- SD , 2.5 + /- 2.1 vs 6.7 + /- 4.4 ; P = .008 ) and a nonsignificant decrease in soiling ( 3.8 + /- 1.6 vs 1.1 + /- 0.5 episodes/wk , P = .1 ) . Daily stimulation does not affect abdominal pain . No adverse events occurred . CONCLUSIONS Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES . Home TES may be a novel treatment of intractable slow transit constipation , avoiding hospital visits PURPOSE We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant , nonneuropathic bladder sphincter dysfunction . MATERIAL S AND METHODS In a prospect i ve study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and /or pharmacotherapy . The device for percutaneous electrical nerve stimulation consists of an interface cable , a surface electrode , a percutaneous needle and a portable stimulator . The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz . for 30 minutes once weekly . Every 6 weeks the children were evaluated . Evaluation parameters were urgency , daytime incontinence , voiding frequency , the uro 
    Output:
    
agent
No significant difference was found between other treatments .
Conclusion Compared with antimuscarinic drugs , PTENS was associated with significant better efficacy considering MVV , but more constipation events in de novo OAB children .
Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose Transcutaneous electrical stimulation ( TES ) speeds up colonic transit in children with slow-transit constipation ( STC ) . This study examined if concurrent upper gastrointestinal dysmotility ( UGD ) affected response to TES . Methods  Radio-nuclear transit studies ( NTS ) were performed before and after TES treatment of STC as part of a larger r and omised controlled trial . UGD was defined as delayed gastric emptying and /or slow small bowel transit . Improvement was defined as increase of ≥1 Geometric Centre ( median radiotracer position at each time [ small bowel = 1 , toilet = 6 ] ) . Results Forty-six subjects completed the trial , 34 had NTS after stimulation ( 21 M , 8–17 years , mean 11.3 years ; symptoms > 9 years ) . Active stimulation increased transit in > 50 % versus only 25 % with sham ( p = 0.04 ) . Seventeen children also had UGD  . In children with STC and either normal upper GI motility ( NUGM ) and UGD , NTS improved slightly after 1 month ( 57 vs. 60 % ; p = 0.9 ) and more after 2 months ( 88 vs. 40 % ; p = 0.07 ) . However , mean transit rate significantly increased with NUGM , but not UGD ( 5.0 ± 0.2 : 3.6 ± 0.6 , p < 0.01 ) . Conclusion Transcutaneous electrical stimulation was beneficial for STC , with response weakly associated with UGD . As measured by NTS , STC children with NUGM responded slightly more , but with significantly greater increased transit compared to those with UGD . Higher numbers are needed to determine if the difference is important PURPOSE We evaluated the effectiveness of parasacral transcutaneous electrical nerve stimulation to treat overactive bladder in children . We design ed a prospect i ve r and omized trial with sham control for this evaluation . MATERIAL S AND METHODS We prospect ively r and omized 25 girls and 12 boys with an average age of 7.6 years ( range 4 to 12 ) into the test ( active treatment ) or sham ( superficial scapular electrical stimulation ) group . A total of 20 sessions , 20 minutes each ( 10 Hz ) were performed 3 times weekly . The criteria used to evaluate the rate of success were 1 ) self-reported cure , or significant , mild or no improvement ; 2 ) visual analogue scale ( level of success 0 to 10 ) ; 3 ) percent improvement ; 4 ) modified Toronto score ; and 5 ) maximum voided volume , average voided volume and number of voids daily based on bladder diary entries . After completion of the 20 sessions controls who were not cured underwent active treatment . RESULTS A total of 21 patients in the test group and 16 in the sham group underwent treatment . Among the active treatment group 61.9 % of parents reported cure . In the sham group no parent reported cure ( p < 0.001 ) . Regarding visual analogue scale a score of 10 was indicated by 13 parents in the test group , while 1 parent in the sham group indicated a score of 9 ( p = 0.002 ) . Additionally 100 % improvement was reported by 12 parents in the test group and no parent in the sham group . Toronto score improved significantly in the test group ( p < 0.001 ) and sham group ( p = 0.008 ) . However , the score was reduced more significantly in the test group compared to the sham group ( p = 0.011 ) . In the test group average and maximum voided volumes showed a statistically significant increase and the number of voids daily decreased . After superficial scapular electrical stimulation 13 of the 16 patients who underwent parasacral transcutaneous electrical nerve stimulation were cured . CONCLUSIONS This is the first known r and omized clinical trial to demonstrate that parasacral transcutaneous electrical nerve stimulation is effective in the treatment of children with overactive bladder BACKGROUND The aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation ( TENS ) treatment improves the results of st and ard urotherapy in children with overactive bladder ( OAB ) symptoms . MATERIAL AND METHODS Sixty-two children with symptoms of OAB and incontinence were included . The children were r and omized either to st and ard urotherapy treatment alone or a combination of st and ard urotherapy and TENS . The effect variables were taken from a voiding-drinking diary : number of voiding , number of incontinence episodes , and maximum voided volume . RESULTS Both treatment groups had good treatment results , with no significant difference between the groups . In the st and ard treatment group 13/28 ( 46 % ) were completely dry and 11/28 ( 40 % ) had a decrease in incontinence episodes , compared to 16/24 ( 67 % ) and 3/24 ( 13 % ) , respectively , in the st and ard+TENS group ( p=0.303 ) . The number of voiding decreased in two-thirds of the patients in both groups . However , maximal voided volume only increased in the st and ard treatment group . Subjectively 72 % and 80 % considered themselves significantly improved or free of symptoms . Previous treatment was registered in 15/55 ( 27 % ) . All efficacy variables decreased in those with previous treatment , but with no difference between the st and ard and st and ard+TENS treatment groups . The only difference noted was when comparing the children without previous treatment in the groups : a significantly higher proportion were completely dry in the TENS group ( 12/18 [ 71 % ] versus 10/22 [ 48 % ] , p=0.05 ) . CONCLUSION Our results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy+TENS , whereas a tendency to difference was found in children without previous treatment . Thus with good urotherapy support , TENS only seems to have marginal additional effects on OAB symptoms INTRODUCTION Overactive bladder ( OAB ) is the most prevalent voiding disorder in childhood , and its main manifestation is urinary urgency . In general , urotherapy and anticholinergics are the first choices of treatment . Parasacral Transcutaneous Electrical Neural Stimulation ( PTENS ) was introduced as an alternative for the treatment of detrusor overactivity in children , but treatment protocol s described to date require several sessions per week or long-lasting sessions , making it difficult for the child to adhere to the treatment . Thus , this study aims to evaluate the effectiveness of PTENS in single weekly sessions in the treatment of OAB in children . STUDY DESIGN This prospect i ve , r and omized controlled trial included 16 children with OAB . Children were divided into two groups : CG ( urotherapy and electrical stimulation placebo ) and EG ( urotherapy and PTENS ) . For both groups , therapy was delivered in 20 weekly sessions , of duration 20 min each . Placebo electrical stimulation was done in the scapular area . The children were evaluated prior to treatment ( T1 ) , at the end of the 20 sessions ( T2 ) , and 60 days after the completion of treatment ( T3 ) , with a 3-day voiding diary , visual analogue scale ( VAS ) , Rome III diagnostic criteria , and the Bristol Scale . RESULTS The groups were similar in age , gender , and ethnicity . In the initial assessment , all children , in both groups , had urgency and incontinence , 50 % in each group had constipation , and enuresis was present in seven children ( 87.5 % ) in the EG and six ( 75 % ) in the CG . No differences were found between the groups regarding the volumetric measurements made in the voiding diary , urinary frequency and constipation evaluated by the Rome III criteria and the Bristol Scale . Sixty days after treatment , a significant improvement was found in the EG group ( p = 0.03 ) regarding urgency ( Table ) , as well as an increase in dry nights in those presenting with enuresis ( p = 0.03 ) . No difference was noted regarding urinary incontinence ( Table ) . At the end of 20 sessions and after 60 days of treatment , those responsible for the children in the EG perceived greater improvement in symptoms measured by the VAS ( p = 0.05 and 0.04 , respectively ) . CONCLUSIONS Our preliminary results demonstrate that PTENS performed in single weekly sessions is effective in treating the bladder for symptoms of urinary urgency and enuresis , and in the perception of those responsible for the children . Further studies with larger population s are needed to corroborate these results BACKGROUND Until now no confirmatory clinical trial in children suffering from nonneurogenic overactive bladder ( OAB ) and urinary incontinence could demonstrate superiority for antimuscarinics over placebo . OBJECTIVES The following study was conducted to prove efficacy and tolerability of propiverine compared to placebo . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blind , placebo-controlled phase 3 trial with parallel-group design in children aged 5 - 10 yr was performed . Prior to the 8-wk medical therapy urologic baseline diagnostics , a 3-wk lifestyle advice ( urotherapy ) was established . INTERVENTION After re-evaluation of in- and exclusion criteria and uroflowmetry , only children fulfilling the requested criteria were allocated to a body-weight-adjusted therapy ( 10 or 15 mg propiverine twice daily or corresponding placebo ) . MEASUREMENTS Efficacy parameters derived from bladder diary and a micturition volume protocol . Decrease in voiding frequency per day was chosen as primary efficacy parameter ; secondary endpoints included voided volume and incontinence episodes . A safety assessment was conducted . RESULTS AND LIMITATIONS Of 171 r and omized children , 87 were treated with propiverine and 84 with placebo .  The primary efficacy parameter showed a decrease in voiding frequency ( -2.0 episodes for propiverine versus -1.2 for placebo ; p=0.0007 ) . Superiority could also be demonstrated for voided volume ( 31.4 vs. 5.1 ml ; p<0.0001 ) and incontinence episodes ( -0.5 vs. -0.2 episodes per d ; p=0.0005 ) . The trial design did not allow for separate evaluation of the effect of urotherapy prior to medical treatment . Propiverine was well-tolerated in children . Altogether 23 % of side-effects were reported for propiverine and 20 % for placebo . CONCLUSIONS This clinical trial showed superior efficacy of propiverine over placebo and good tolerability for the treatment of children suffering from OAB and urinary incontinence . An important additional factor for the success of the trial was a modified trial design with previous urotherapy . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00603343 PURPOSE Transcutaneous electrical stimulation ( TES ) ( 3 sessions/wk ) over the abdomen stimulated bowel functions in a r and omized controlled trial . This pilot study assessed whether daily TES at home with a safe , portable machine would be possible and more efficacious than trial results . METHODS Eleven patients ( 6 male/5 female ; mean age , 14 years ; range , 12 - 18 years ) with slow-transit constipation who relapsed or responded poorly in the trial were recruited ( 11 + /- 5 months later ) . An EPM-IF-4160 ( Fuji Dynamics , Hong Kong ) portable machine ( sine waveform , 4 kHz carrier frequency , 80 - 160 Hz beat frequency , intensity <33 mA ) delivering interferential current ( 2 electrodes over epigastrium + 2 over kidneys ) was applied 1 hour daily at home . Continence diaries were kept for 1 month before and 2 months during treatment . RESULTS All children completed more than 1 month of treatment after baseline recording . Defecation increased in 9 of 11 children , and soiling decreased in 4 of 11 children . There was a significant increase in total episodes of defecation per week ( mean + /- SD , 2.5 + /- 2.1 vs 6.7 + /- 4.4 ; P = .008 ) and a nonsignificant decrease in soiling ( 3.8 + /- 1.6 vs 1.1 + /- 0.5 episodes/wk , P = .1 ) . Daily stimulation does not affect abdominal pain . No adverse events occurred . CONCLUSIONS Daily TES at home is safe and significantly improved bowel function in children who did not respond to 3 times per week of TES . Home TES may be a novel treatment of intractable slow transit constipation , avoiding hospital visits PURPOSE We evaluated the effect of percutaneous electrical nerve stimulation on voiding dysfunction in a group of children with therapy resistant , nonneuropathic bladder sphincter dysfunction . MATERIAL S AND METHODS In a prospect i ve study 17 boys and 15 girls with mean age of 11.7 years underwent percutaneous electrical nerve stimulation after the failure of more than 2 years of urological and /or pharmacotherapy . The device for percutaneous electrical nerve stimulation consists of an interface cable , a surface electrode , a percutaneous needle and a portable stimulator . The needle is inserted at the tibial nerve level and a portable stimulator provided pulsations at a frequency of 20 Hz . for 30 minutes once weekly . Every 6 weeks the children were evaluated . Evaluation parameters were urgency , daytime incontinence , voiding frequency , the uro 
    Output:
    