Combined transcranial and sacral magnetic stimulation in primary monosymptomatic nocturnal enuresis: a randomized controlled study

Abstract Background Primary nocturnal enuresis (PNE) is defined as recurrent voiding of urine into bed or clothing, causing distress or impairment in social, academic, or other critical areas. Despite neuroimaging data and brain models, targeted therapeutic approaches are lacking. Magnetic stimulation, including transcranial and direct sacral stimulation, could be a potential treatment for nocturnal enuresis. Results 40 patients with PNE were recruited and randomly distributed into 2 groups. Group (I): 22 patients received real magnetic stimulation (transcranial and direct sacral root stimulation) and Group (II): 18 patients received sham stimulation as a control group. Patients were evaluated before, immediately after the sessions, 1 and 3 months after sessions, assessing frequency of wet nights, quality of life according to International Consultation on Incontinence Questionnaire–Lower Urinary Tract Symptom Quality of Life (ICIQ–LUTS qol) score and motor threshold (MT) as a measure for brain excitability and neuronal integrity. There was a substantial reduction in the frequency of wet nights per week for the treatment group compared to the control group, with a significant difference observed after 1 month ( P value 0.086) and 3 months ( P value < 0.001). MT assessment showed alterations in cortical excitability, with a significant difference observed at dates 2, 3 (P value 0.044, < 0.001). The clinical improvement was associated with correlated improvement in the quality of life, although it was not significantly observed immediately after the sessions. The International Children’s Continence Society (ICCS) criteria response rate showed a higher response rate for the real stimulation with no significant adverse effects. Conclusions The research highlights the effectiveness and safety of using both transcranial and sacral magnetic stimulation in treating pediatric patients with PMNE. To maximize therapeutic success in this patient population, more research is required to clarify the mechanisms of action and improve therapy regimens.