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Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder

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Abstract

Purpose

Percutaneous tibial nerve stimulation is a minimally invasive neuromodulation technique for treating overactive bladder symptoms. The aim of this study was to assess safety, efficacy and impact on quality of life of percutaneous tibial nerve stimulation in neurological patients reporting overactive bladder symptoms.

Methods

In this retrospective evaluation over 18 months at a tertiary healthcare centre, patients finding first-line treatments for overactive bladder ineffective or intolerable underwent a standard 12-week course of percutaneous tibial nerve stimulation (Urgent PC, Uroplasty). Symptoms were evaluated using standardised International Consultation on Incontinence Questionnaires and bladder diaries.

Results

Of 74 patients (52 women, 22 men, mean age 56 years), 49 (66.2%) patients had neurological disorder [19 (25.7%) multiple sclerosis and 30 (40.5%) other neurological conditions] and 25 (33.8%) idiopathic overactive bladder. Overall for the entire cohort significant improvements were recorded after 12 weeks in the following domains: 24-h frequency on bladder diary − 1.67 (− 3.0, 0.33) (p = 0.002), number of incontinent episodes on bladder diary − 0.0 (− 1, 0) (p = 0.01), incontinence severity on bladder diary 0 (− 0.33, 0) (p = 0.007), OAB symptoms − 3 (− 11.5, 5) (p = 0.01), and quality of life − 16 (− 57, 6.5) (p = 0.004). There were no significant differences in outcomes between patients with idiopathic and neurogenic overactive bladder.

Conclusions

Percutaneous tibial nerve stimulation appears to be a possible promising alternative for patients with neurological disorder reporting overactive bladder symptoms who find first-line treatments either ineffective or intolerable. However, a properly designed study is required to address safety and efficacy.

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References

  1. McGuire EJ, Zhang SC, Horwinski ER, Lytton B (1983) Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol 129(1):78–79

    Article  CAS  Google Scholar 

  2. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A medium-term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compliance. Br J Obstet Gynaecol 104(9):988–993

    Article  CAS  Google Scholar 

  3. Sievert KD, Nagele U, Pannek J, Engeler D, Kuczyk M, Stenzl A (2007) Subcutaneous tunneling of the temporary testing electrode significantly improves the success rate of subchronic sacral nerve modulation (SNM). World J Urol 25(6):607–612. https://doi.org/10.1007/s00345-007-0204-5

    Article  PubMed  Google Scholar 

  4. Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, Daniell G, Heesakkers J, Haag-Molkenteller C (2011) Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 60(4):742–750. https://doi.org/10.1016/j.eururo.2011.07.002

    Article  CAS  PubMed  Google Scholar 

  5. Govier FE, Litwiller S, Nitti V, Kreder KJ Jr, Rosenblatt P (2001) Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol 165(4):1193–1198

    Article  CAS  Google Scholar 

  6. MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC, Siegel SW, Tate SB, Feagins BA (2010) Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol 183(1):234–240. https://doi.org/10.1016/j.juro.2009.08.160

    Article  PubMed  Google Scholar 

  7. Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, Macdiarmid SA (2010) Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol 183(4):1438–1443. https://doi.org/10.1016/j.juro.2009.12.036

    Article  PubMed  Google Scholar 

  8. NICE interventional procedures guidance [IPG362] (2010) Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome. https://www.nice.org.uk/Guidance/ipg362

  9. NICE Clinical guideline [CG171] (2013) Urinary incontinence in women: management. https://www.nice.org.uk/guidance/cg171 (Last updated: November 2015)

  10. Kabay SC, Yucel M, Kabay S (2008) Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: urodynamic study. Urology 71(4):641–645. https://doi.org/10.1016/j.urology.2007.11.135

    Article  PubMed  Google Scholar 

  11. Kabay SC, Kabay S, Yucel M, Ozden H (2009) Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Neurourol Urodyn 28(1):62–67. https://doi.org/10.1002/nau.20593

    Article  PubMed  Google Scholar 

  12. Kabay S, Kabay SC, Yucel M, Ozden H, Yilmaz Z, Aras O, Aras B (2009) The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction. Neurourol Urodyn 28(8):964–968. https://doi.org/10.1002/nau.20733

    Article  PubMed  Google Scholar 

  13. Gobbi C, Digesu GA, Khullar V, El Neil S, Caccia G, Zecca C (2011) Percutaneous posterior tibial nerve stimulation as an effective treatment of refractory lower urinary tract symptoms in patients with multiple sclerosis: preliminary data from a multicentre, prospective, open label trial. Mult Scler 17(12):1514–1519. https://doi.org/10.1177/1352458511414040

    Article  CAS  PubMed  Google Scholar 

  14. Zecca C, Digesu GA, Robshaw P, Puccini F, Khullar V, Tubaro A, Gobbi C (2014) Motor and sensory responses after percutaneous tibial nerve stimulation in multiple sclerosis patients with lower urinary tract symptoms treated in daily practice. Eur J Neurol 21(3):506–511. https://doi.org/10.1111/ene.12339

    Article  CAS  PubMed  Google Scholar 

  15. Zecca C, Digesu GA, Robshaw P, Singh A, Elneil S, Gobbi C (2014) Maintenance percutaneous posterior nerve stimulation for refractory lower urinary tract symptoms in patients with multiple sclerosis: an open label, multicenter, prospective study. J Urol 191(3):697–702. https://doi.org/10.1016/j.juro.2013.09.036

    Article  CAS  PubMed  Google Scholar 

  16. Zecca C, Panicari L, Disanto G, Maino P, Singh A, Digesu GA, Gobbi C (2016) Posterior tibial nerve stimulation in the management of lower urinary tract symptoms in patients with multiple sclerosis. Int Urogynecol J 27(4):521–527. https://doi.org/10.1007/s00192-015-2814-6

    Article  PubMed  Google Scholar 

  17. de Seze M, Raibaut P, Gallien P, Even-Schneider A, Denys P, Bonniaud V, Game X, Amarenco G (2011) Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol Urodyn 30(3):306–311. https://doi.org/10.1002/nau.20958

    Article  PubMed  Google Scholar 

  18. Finazzi-Agro E, Rocchi C, Pachatz C, Petta F, Spera E, Mori F, Sciobica F, Marfia GA (2009) Percutaneous tibial nerve stimulation produces effects on brain activity: study on the modifications of the long latency somatosensory evoked potentials. Neurourol Urodyn 28(4):320–324. https://doi.org/10.1002/nau.20651

    Article  PubMed  Google Scholar 

  19. Peters KM, Carrico DJ, MacDiarmid SA, Wooldridge LS, Khan AU, McCoy CE, Franco N, Bennett JB (2013) Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Neurourol Urodyn 32(1):24–29. https://doi.org/10.1002/nau.22266

    Article  PubMed  Google Scholar 

  20. Burton C, Sajja A, Latthe PM (2012) Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn 31(8):1206–1216. https://doi.org/10.1002/nau.22251

    Article  CAS  PubMed  Google Scholar 

  21. Donovan JL, Abrams P, Peters TJ, Kay HE, Reynard J, Chapple C, De La Rosette JJ, Kondo A (1996) The ICS-‘BPH’ study: the psychometric validity and reliability of the ICSmale questionnaire. Br J Urol 77(4):554–562

    Article  CAS  Google Scholar 

  22. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P (1996) The Bristol female lower urinary tract symptoms questionnaire: development and psychometric testing. Br J Urol 77(6):805–812

    Article  CAS  Google Scholar 

  23. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104(12):1374–1379

    Article  CAS  Google Scholar 

  24. Nystrom E, Sjostrom M, Stenlund H, Samuelsson E (2014) ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn. https://doi.org/10.1002/nau.22657

    Article  PubMed  Google Scholar 

  25. Blaivas JG, Panagopoulos G, Weiss JP, Somaroo C, Chaikin DC (2007) The urgency perception score: validation and test-retest. J Urol 177(1):199–202. https://doi.org/10.1016/j.juro.2006.08.091

    Article  PubMed  Google Scholar 

  26. Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B, Kerdraon J (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169(6):2210–2215. https://doi.org/10.1097/01.ju.0000067446.17576.bd

    Article  CAS  PubMed  Google Scholar 

  27. Kabay S, Canbaz Kabay S, Cetiner M, Mestan E, Sevim M, Ayas S, Ozden H, Ozisik Karaman H (2016) The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Urology 87:76–81. https://doi.org/10.1016/j.urology.2015.09.026

    Article  PubMed  Google Scholar 

  28. Fowler CJ, Griffiths D, de Groat WC (2008) The neural control of micturition. Nat Rev Neurosci 9(6):453–466. https://doi.org/10.1038/nrn2401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Panicker JN, Fowler CJ, Kessler TM (2015) Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol 14(7):720–732. https://doi.org/10.1016/S1474-4422(15)00070-8

    Article  PubMed  Google Scholar 

  30. Birder L, de Groat W, Mills I, Morrison J, Thor K, Drake M (2010) Neural control of the lower urinary tract: peripheral and spinal mechanisms. Neurourol Urodyn 29(1):128–139. https://doi.org/10.1002/nau.20837

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, Siegel SW, Tate SB, Jarnagin BK, Rosenblatt PL, Feagins BA (2009) Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 182(3):1055–1061. https://doi.org/10.1016/j.juro.2009.05.045

    Article  CAS  PubMed  Google Scholar 

  32. Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agro E (2013) Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol 13:61. https://doi.org/10.1186/1471-2490-13-61

    Article  PubMed  PubMed Central  Google Scholar 

  33. Schneider MP, Gross T, Bachmann LM, Blok BF, Castro-Diaz D, Del Popolo G, Groen J, Hamid R, Karsenty G, Pannek J, Hoen L, Kessler TM (2015) Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review. Eur Urol 68(5):859–867. https://doi.org/10.1016/j.eururo.2015.07.001

    Article  PubMed  Google Scholar 

  34. Blok B et al (2016) EAU guidelines on neuro-urology. European association of urology. https://uroweb.org/wp-content/uploads/EAU-Guidelines-Neuro-urology-2016-1.pdf

  35. Nuhoglu B, Fidan V, Ayyildiz A, Ersoy E, Germiyanoglu C (2006) Stoller afferent nerve stimulation in woman with therapy resistant over active bladder; a 1-year follow up. Int Urogynecol J Pelvic Floor Dysfunct 17(3):204–207. https://doi.org/10.1007/s00192-005-1370-x

    Article  PubMed  Google Scholar 

  36. van der Pal F, van Balken MR, Heesakkers JP, Debruyne FM, Bemelmans BL (2006) Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary? BJU Int 97(3):547–550. https://doi.org/10.1111/j.1464-410X.2006.06055.x

    Article  PubMed  Google Scholar 

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Acknowledgements

The work was undertaken at UCLH/UCL Institute of Neurology and is supported in part by funding from the United Kingdom’s Department of Health NIHR Biomedical Research Centres funding scheme. JS was awarded funding from The Urology Foundation and InComb project. KIT received funding from The Urodynamics Fellowship International Continence Society, support from the Department to Department Cooperation Programme EFNS and was awarded the Newsom–Davis Visiting Fellowship Guarantors of Brain. MDL received funding from the Swiss National Science Foundation (fellowship P2EZP3_148749, P300PB_161087), joint research funding from UCL and the Neuroscience Center Zürich, and the UK Multiple Sclerosis Society. Authors would like to acknowledge the support of The National Brain Appeal through a Small Acorns Grant.

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Author notes

  1. Katarina Ivana Tudor and Jai H. Seth share first authorship of this manuscript.

Authors and Affiliations

  1. Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, UK

    Katarina Ivana Tudor, Jai H. Seth, Martina D. Liechti, Juliana Ochulor, Gwen Gonzales, Collette Haslam, Mahreen Pakzad & Jalesh N. Panicker

  2. Department of Neurology, University Hospital Center Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia

    Katarina Ivana Tudor

  3. Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK

    Martina D. Liechti

  4. Spinal Cord Injury Center, University of Zurich, Balgrist University Hospital, Zurich, Switzerland

    Martina D. Liechti

  5. Biostatistics Group, University College London Hospitals and University College London Research Support Centre, University College London, London, UK

    Zoe Fox

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Tudor, K.I., Seth, J.H., Liechti, M.D. et al. Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder. Clin Auton Res 30, 61–67 (2020). https://doi.org/10.1007/s10286-018-0553-8

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