Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder Syndrome: Clinical Effectiveness, Urodynamic, and Durability Evaluation.

OBJECTIVE: To evaluate percutaneous tibial nerve stimulation (PTNS) effectiveness, durability, and impact on the pathophysiology of overactive bladder syndrome (OAB) in patients who have been previously treated with antimuscarinics without success. MATERIALS AND METHODS: A prospective study that included 200 women diagnosed with OAB between 2007 and 2015 at Virgen de la Victoria University Hospital (Málaga, Spain) was conducted. OAB patients were treated with PTNS therapy after antimuscarinic treatment failed. To evaluate OAB symptoms, clinical and urodynamic studies were performed before and after PTNS treatment. Treatment's success was defined as a reduction of clinical parameters by >50% and an improvement of at least 2 urodynamic parameters by >50%. The Kolmogorov-Smirnov test and Student's t test or Wilcoxon test were used based on the data. A linear correlation analysis and a multivariate linear regression analysis were performed to determine factors associated with the success of PTNS therapy. RESULTS: Of the patients, 94% experienced a positive response to PTNS considering clinical and urodynamic parameters. PTNS benefits were extended by 24 months. We identified daytime urinary frequency (r = -0.165; P = .024; 95% confidence interval, -0.248 to -0.018) and first sensation of bladder filling (r = 0.208; P = .030; 95% confidence interval, 0.001-0.028) as significant independent predictor factors for PTNS success. CONCLUSION: The current data confirmed a high effectiveness of PTNS improving OAB symptoms through 24 months. Furthermore, daytime urinary frequency and first sensation of bladder filling act as a significant independent predictor factors for PTNS success.

Percutaneous tibial nerve stimulation in treatment of overactive bladder: when should retreatment be started?

OBJECTIVE: To study the response to posterior tibial nerve stimulation in patients with overactive bladder refractory to medical treatment. METHODS: A cohort of 53 patients were treated by posterior tibial nerve stimulation and followed up for a maximum of 24 months. All patients completed the International Consultation on Incontinence Modular Questionnaire-Short Form quality of life questionnaire and kept a urination diary to record the daytime urination frequency and night-time urination frequency. Urodynamic studies were also conducted. RESULTS: At 6 months of follow-up, a cure/improvement rate of 92.4% (49 of 53 cases) had been achieved. Ten patients were given additional treatment and were excluded from subsequent follow-up analysis. At 12 months of follow-up, a cure/improvement rate of 91.69% had been achieved (39 of 43). At 24 months of follow-up, of the 16 patients initially included during the first year, a cure/improvement rate of 62.5% had been achieved (10 of 16). The first sensation of bladder filling had increased by the end of treatment, with differences observed before and after posterior tibial nerve stimulation (P ≤ .001). The average post-treatment bladder capacity had increased by 72.7 mL compared with the initial value (P ≤ .001). At 24 months of follow-up, the group of 16 patients evaluated recorded a significant worsening of night-time urination frequency (P ≤ .05) and quality of life (P ≤ .01). CONCLUSION: Posterior tibial nerve stimulation is a good option for the treatment of overactive bladder. In our series, the optimal point to start retreatment would be at 24 months after therapy completion.