Percutaneous tibial nerve stimulation for overactive bladder
01 Oct 2014-Journal of Neurology, Neurosurgery, and Psychiatry (BMJ Publishing Group Ltd)-Vol. 85, Iss: 10
TL;DR: Percutaneous Tibial Nerve Stimulation is a safe and effective treatment in patients with neurological disorders, associated with significant improvements in overactive bladder symptoms and quality of life.
Abstract: Background Percutaneous Tibial Nerve Stimulation (PTNS) is a minimally invasive neuromodulation technique for treatment of overactive bladder (OAB). The aim of this study was to assess safety and efficacy in neurological patients. Methods In this prospective evaluation over 18 months at a tertiary centre, patients finding first-line treatments for OAB ineffective or intolerable underwent standard 12-week course of PTNS (Urgent PC, Uroplasty). Symptoms were evaluated using standardised questionnaires (ICIQ-OAB and ICIQLUTS-QoL) and bladder diaries. Results Of 74 consecutive patients (52 males; mean age 57; 25(33.8%) idiopathic OAB, 19 (25.7%) multiple sclerosis (MS), 30 (40.5%) other neurological conditions), 64(86%) completed treatment. Significant improvements (p Conclusions PTNS is a safe and effective treatment in patients with neurological disorders, associated with significant improvements in overactive bladder symptoms and quality of life.
Citations
More filters
TL;DR: A review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
Abstract: Overactive bladder affects millions of adults, with profound personal and economic costs. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest, and many patients are intolerant of the side effects, or do not experience sufficient relief. For these patients, the modulation of bladder reflex pathways via percutaneous tibial nerve stimulation (PTNS) or via implanted sacral nerve stimulation (SNS) has been acknowledged as a logical next step in the algorithm of care. This review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
73 citations
TL;DR: Electrical pudendal nerve stimulation is more effective than transvaginal electrical stimulation in treating drug refractory, female idiopathic urgency urinary incontinence.
30 citations
Journal Article•
TL;DR: There is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB and PTNS is proven significantly better than sham procedure.
Abstract: Aim : to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods : we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results : we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion : there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure. Key words : overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms.
30 citations
Additional excerpts
...13 Van Der Pal et al, 200623 NRCT mixed PTNS 51 (33-66) 11 30 min; 3x/weeks 4 week 14 Agro et al, 200524 RCT mixed PTNS 17 30 min; 1x/week 12 weeks...
[...]
...1 (21-82) 83 30 min; 1x/week 12 weeks 12 Nuhoglu et al, 200622 NRCT females PTNS 47....
[...]
...Solifenacin 61 (35-79) 14 5 mg; 1x/day 40 days...
[...]
TL;DR: As technology improves, an intelligent neuroprosthesis with the ability to sense significant bladder events may revolutionize treatment of OAB.
Abstract: Overactive bladder (OAB) affects millions of people around the world and decreases quality of life for those affected. Over the past two decades, significant advances in treatment have transformed the lives of those with OAB. Sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and dorsal genital nerve stimulation are the most effective contemporary treatment modalities. New techniques and bio-sensing schemes offer promise to advance therapy beyond what is currently available. Current neuromodulation techniques do not use real-time data from the body or input from the patient. Incorporating this is the goal of those pursuing a neuroprosthesis to enhance bladder function for these patients. Dorsal genital nerve, pudendal nerve, S3 afferent nerve roots, and S1 and S2 ganglia have all been used as targets for stimulation. Some of these have also been used as sources of afferent nerve information to detect significant bladder events and even to estimate the fullness of the bladder. As technology improves, an intelligent neuroprosthesis with the ability to sense significant bladder events may revolutionize treatment of OAB.
17 citations
TL;DR: The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI).
Abstract: Overactive bladder (OAB) is a syndrome of urinary urgency, usually accompanied by frequency, nocturia, and sometimes urinary urgency incontinence. There are many guidelines for the OAB treatment which are constructed on a stepwise fashion starting from the least invasive to the more invasive therapy. The emergence of third-line therapy (AUA/SUFU guidelines) has resulted in significant decrease of more invasive surgery and improved patients’ quality of life. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction, and increase the efficiency in the use of resources. The available options for the third-line OAB treatments include intravesical injection of botulinum toxin A, percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS). The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI). The choice among the different third-line treatment depends on patient preference, availability, and local expertise. The application of these pathways can improve incontinence care by letting physicians adequately communicate with patients and select individualized therapy at an early stage especially for elderly patients.
4 citations
References
More filters
TL;DR: A review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
Abstract: Overactive bladder affects millions of adults, with profound personal and economic costs. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest, and many patients are intolerant of the side effects, or do not experience sufficient relief. For these patients, the modulation of bladder reflex pathways via percutaneous tibial nerve stimulation (PTNS) or via implanted sacral nerve stimulation (SNS) has been acknowledged as a logical next step in the algorithm of care. This review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
73 citations
TL;DR: Electrical pudendal nerve stimulation is more effective than transvaginal electrical stimulation in treating drug refractory, female idiopathic urgency urinary incontinence.
30 citations
Journal Article•
TL;DR: There is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB and PTNS is proven significantly better than sham procedure.
Abstract: Aim : to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods : we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results : we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion : there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure. Key words : overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms.
30 citations
TL;DR: As technology improves, an intelligent neuroprosthesis with the ability to sense significant bladder events may revolutionize treatment of OAB.
Abstract: Overactive bladder (OAB) affects millions of people around the world and decreases quality of life for those affected. Over the past two decades, significant advances in treatment have transformed the lives of those with OAB. Sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and dorsal genital nerve stimulation are the most effective contemporary treatment modalities. New techniques and bio-sensing schemes offer promise to advance therapy beyond what is currently available. Current neuromodulation techniques do not use real-time data from the body or input from the patient. Incorporating this is the goal of those pursuing a neuroprosthesis to enhance bladder function for these patients. Dorsal genital nerve, pudendal nerve, S3 afferent nerve roots, and S1 and S2 ganglia have all been used as targets for stimulation. Some of these have also been used as sources of afferent nerve information to detect significant bladder events and even to estimate the fullness of the bladder. As technology improves, an intelligent neuroprosthesis with the ability to sense significant bladder events may revolutionize treatment of OAB.
17 citations
TL;DR: The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI).
Abstract: Overactive bladder (OAB) is a syndrome of urinary urgency, usually accompanied by frequency, nocturia, and sometimes urinary urgency incontinence. There are many guidelines for the OAB treatment which are constructed on a stepwise fashion starting from the least invasive to the more invasive therapy. The emergence of third-line therapy (AUA/SUFU guidelines) has resulted in significant decrease of more invasive surgery and improved patients’ quality of life. The aim of a clinical pathway is to improve the quality of care, reduce risks, increase patient satisfaction, and increase the efficiency in the use of resources. The available options for the third-line OAB treatments include intravesical injection of botulinum toxin A, percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS). The available evidence confirms that all three treatment approaches are well tolerated and effective, although only botulinum toxin type A (BoNTA) and SNS can achieve nearly a cure of urgency urinary incontinence (UUI). The choice among the different third-line treatment depends on patient preference, availability, and local expertise. The application of these pathways can improve incontinence care by letting physicians adequately communicate with patients and select individualized therapy at an early stage especially for elderly patients.
4 citations