Correlation between quality of life and voiding variables in patients treated with percutaneous tibial nerve stimulation

Evaluation of satisfaction of pelvic floor muscle training isolated and associated with tibial nerve stimulation in women with mixed urinary incontinence: A randomized, single-blinded clinical trial

OBJECTIVES

To compare the satisfaction degree and pelvic floor manometry after pelvic floor muscle training isolated and associated with tibial nerve stimulation in women with mixed urinary incontinence (MUI).

STUDY DESIGN

A randomized, single-blinded clinical trial was conducted. 24 women diagnosed with MUI were equally divided into two groups: pelvic floor muscle training isolated and associated to transcutaneous tibial nerve stimulation (TTNS). The study occurred in four stages: 1) evaluation: general information, pelvic floor manometry, the International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF) and International Consultation on Incontinence Questionnaire - Overactive Bladder (OAB) application; 2) intervention: carried out over 2 months twice a week; 3) post-intervention evaluation: vaginal manometry, reapplication of the questionnaires and the Patient Global Impression (PGI) application at the end of the 2-month intervention; and, 4) follow-up: evaluation after 1 month of the end of the intervention. The primary outcome was the ICIQ-UI-SF and the secondary outcomes were ICIQ-OAB, vaginal manometry, and PGI. The repeated measures ANOVA was used to assess the time-to-group interaction by assigning a significance level of 5%.

RESULTS

There was no interaction between time and group for ICIQ-UI-SF (p = 0.17) and manometry (p = 0.56). There was interaction for ICIQ-OAB (p < 0.01). PGI was reported as "much better" with 41.67% in the PFMTG + TTNS and 16.67% in the PFMTG after the intervention (p = 0.04).

CONCLUSIONS

The results showed weak evidence that TTNS, in combination with PFMT, may be an intervention that can be used to treat MUI. The satisfaction degree was better with associated intervention.

Transcutaneous tibial nerve home stimulation for overactive bladder in women with Parkinson's disease: A randomized clinical trial

AIMS

This study aims to investigate the efficacy of transcutaneous tibial nerve home stimulation for overactive bladder (OAB) in women with Parkinson's disease (PD).

METHODS

The current study is a prospective, randomized, double-blind, sham-controlled trial. Home intervention was carried out and assessments were conducted at a tertiary hospital in South Brazil. Women with PD and OAB symptoms were included in the study. Patients were randomly divided into two groups: (1) stimulation and (2) sham. Both groups underwent intervention at home for 12 weeks. Patients were evaluated at baseline and at 12 weeks (end of intervention), 30- and 90-day follow-up. The primary outcome was the mean reduction in the number of urgency incontinence episodes, and secondary outcomes included daytime and nighttime urinary frequency, urinary urgency episodes, use of pad (reported in a 24-h bladder diary), OAB-V8 and King's Health Questionnaire scores, and maintenance of symptom relief after discontinuation of the intervention.

RESULTS

In total, 30 consecutive patients completed the study (15/group). The stimulation group showed a reduction in nighttime urinary frequency (0.9 ± 0.6), urinary urgency (1.0 ± 1.2), urgency incontinence episodes (0.5 ± 0.6), use of pads (1.3 ± 1.2), and OAB-V8 (1.3 ± 1.2) and King's Health Questionnaire scores. In a 30-day and 90-day follow-up, 8 (53.3%) and 5 (33.3%) stimulation patients, respectively, reported full maintenance of symptom relief after discontinuation of the intervention. Stimulation patients presented a statistically significant improvement of symptoms as compared with sham patients (p = .001).

CONCLUSIONS

Transcutaneous tibial nerve home stimulation can be used in clinical practice as an effective nonpharmacological resource for the reduction of OAB symptoms in women with PD, and the resulting relief seems to persist in the follow-up (30 and 90 days).

Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine and was first described in the early 1980s. It is a neuromodulation technique used to modulate bladder function and facilitate storage. Being a minimally invasive, easily applicable, but time-consuming treatment, future developments with implantable devices might be the solution for the logistical problems and economic burden associated with PTNS on the long term. This nonsystematic review provides a current overview on PTNS and its effectiveness in the treatment of OAB for both adults and children.

Effects of Physiotherapy in the Treatment of Neurogenic Bladder in Patients Infected With Human T-Lymphotropic Virus 1

OBJECTIVE

To evaluate the efficacy of physiotherapy for urinary manifestations in patients with human T-lymphotropic virus 1-associated lower urinary tract dysfunction.

METHODS

Open clinical trial was conducted with 21 patients attending the physiotherapy clinic of the Hospital Universitário, Bahia, Brazil. Combinations of behavioral therapy, perineal exercises, and intravaginal or intra-anal electrical stimulation were used.

RESULTS

The mean age was 54 ± 12 years and 67% were female. After treatment, there was an improvement in symptoms of urinary urgency, frequency, incontinence, nocturia, and in the sensation of incomplete emptying (P < .001). There was also a reduction in the overactive bladder symptom score from 10 ± 4 to 6 ± 3 (P < .001) and an increase in the perineal muscle strength (P <.001). The urodynamic parameters improved, with reduction in the frequency of patients with detrusor hyperactivity from 57.9% to 42.1%, detrusor-sphincter dyssynergia from 31.6% to 5.3%, detrusor hypocontractility from 15.8% to 0%, and detrusor areflexia from 10.5% to 0%, with positive repercussions in the quality of life in all patients.

CONCLUSION

Physiotherapy was effective in cases of human T-lymphotropic virus 1-associated neurogenic bladder, reducing symptoms, increasing perineal muscle strength, and improving urodynamic parameters and quality of life.

Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial

INTRODUCTION AND HYPOTHESIS

The aim of this study was to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation (T.C. PTNS) versus extended release oxybutynin (E.R.O.) in patients with overactive bladder.

MATERIALS AND METHODS

Seventy female patients were randomized to receive either 10mg E.R.O. daily or T.C. PTNS, using a TENS machine program with the 20Hz, 200 cycles/s, and normal stimulation setting for two 30-min sessions, each week for a 12-week period. Pre-treatment and after the 12-week intervention, each patient completed a 3-day voiding diary and a self-report quality of life questionnaire (OAB-q). Statistical analysis was performed using Stata V12.1.

RESULTS

Sixty-four patients completed the treatment protocol. There were no significant differences between study groups in terms of age, body mass index, past hormone replacement therapy, smoking habits, menopause status, and parity. Prior to treatment, there were also no significant differences in the analysis of the 3-day voiding diary or in the OAB-q questionnaire results. Following the 12-week study, there was a statistically significant reduction in frequency of urination, urgency episodes, and urge incontinent episodes compared to pre-treatment values. However, there were no significant differences in these values between intervention groups after 12-weeks of therapy. There was a similar improvement in OAB-q scores in both treatment groups following therapy, and the T.C. PTNS group showed a statistically significant improvement over the E.R.O. in domain 2 of the OAB-q questionnaire. The other two domains showed similar improvement in both study groups.

CONCLUSION

T.C. PTNS and E.R.O. demonstrated similar improvements in subjects with OAB in a 12-week study.

Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review

Background

Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions.

Methods

A literature search using MEDLINE and ISI web was performed. Search terms used were “tibial nerve” and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed.

Results

PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.

Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered.

Conclusions

PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.

Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis

AIM

To evaluate the effectiveness of posterior percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder (OAB) symptoms by systematic review of the literature.

METHODS

Systematic literature search was carried out (up to April 2011) using relevant search terms in Medline, EMBASE, CINAHL, CENTRAL, National Library for Health, MetaRegister of controlled trials, LILACS, and Google Scholar. Relevant randomized controlled trials (RCTs) and prospective studies were selected and then analyzed by two-independent reviewers. Meta-analysis was performed with random effects model using STATA 8 for non-randomized prospective studies and with Review Manager 5.1 for RCTs.

RESULTS

The studies report variable initial success rates (37-82%) for treating OAB symptoms with PTNS. Four randomized trials compared PTNS with Sham treatment showing a significant difference favoring PTNS [RR 7.02 95% confidence interval (CI) 1.69-29.17]. Two randomized trials compared PTNS with antimuscarinic medication with no significant difference in the change in bladder diary parameters between the treatments. Ten prospective non-randomized studies were included. The definitions of success were varied. The pooled subjective success rate was 61.4% (95% CI 57.5-71.8) and objective success rate was 60.6% (95% CI 49.2-74.7).

CONCLUSION

There is evidence of significant improvement in OAB symptoms using PTNS which is comparable to the effect of antimuscarinics but with a better side effect profile. The studies included in the review only considered short-term outcomes after initial treatment. In order to recommend PTNS as a practical treatment option, long-term data and health economic analysis are needed.

Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionário específico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinárias e incômodos ocasionados foram avaliados, respectivamente, por meio do diário miccional de 24 horas e Escala Visual Analógica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em três domínios do I-QOL, na EVA, que avaliou o grau de incômodo causado pela IU e em quatro aspectos do diário miccional. No grupo de ET houve melhora significativa de dois domínios do SF-36, três domínios do I-QOL, na EVA e em quatro aspectos do diário. Houve melhora da QV em ambos os grupos, assim como uma diminuição das queixas de perda urinária, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois domínios do questionário de QV genérico após o tratamento, que teve limitação por aspectos físicos e limitação por aspectos emocionais. O que não ocorreu com o grupo de ENT.

Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study

AIMS

Electrostimulation is an established therapeutic option for neurogenic urinary disorders. The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with multiple sclerosis (MS) and troublesome symptoms of an overactive bladder (OAB).

METHODS

A multicentric study enrolled 70 MS patients, suffering from OAB for a 3-month study period.

INTERVENTION

Daily sessions of 20 min of TPTNS were provided. No change of associated treatments during the study period. The primary outcome measurement was Urgency and Frequency reported by bladder diary and symptom score performed before the treatment (Day 0, D0) and at D30 and D90. The secondary outcomes measurements were continence, symptom score, quality of life, psychosocial burden at DO, D30, and D90 and cystometry at baseline, with and without TPTNS and at D90.

RESULTS

Clinical improvement of OAB was shown in 82.6% and 83.3% of the patients on D30 and D90, respectively, with significant improvement of primary and secondary outcomes compared to baseline. The initial acute cystometric response to TPTNS was positive in 51.2% of the patients (increase of >30% of cystometric capacity and/or reflex volume), without correlation with TPTNS clinical efficiency. The procedure was well tolerated.

CONCLUSIONS

Chronic TPTNS appears to be effective in the management of severe OAB in MS, without compromising bladder emptying or inducing side effect. Treatment may be effective even in the absence of an acute cystometric effect. Additional works are required to demonstrate long-term efficacy of TPTNS.

Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?

INTRODUCTION

Faecal incontinence is a prevalent and important condition, with a range of treatment options. Neuromodulation via sacral nerve stimulators is efficacious, but expensive and associated with complications due to device implantation. Peripheral neuromodulation via posterior tibial nerve stimulation (PTNS) has been assessed in urinary incontinence, but there is minimal evidence for its use in faecal incontinence and no literature from the UK. This retrospective review aimed to assess the efficacy of PTNS in faecal incontinence.

PATIENTS AND METHODS

Thirteen consecutive female patients with faecal incontinence of various causes (9 idiopathic, 3 obstetric, 1 surgery) underwent PTNS at a UK hospital. All were investigated with colonic imaging, anorectal physiology and endo-anal ultrasound. Prior treatments included physiotherapy (13), sphincteroplasty (3) biofeedback (3) and PTQ implants (1). PTNS was performed for 30 min, weekly for 12 weeks.

RESULTS

Median monthly episodes of incontinence of wind, liquid and solid reduced from 6, 10 and 18 respectively to 0 with 12 weeks' treatment (P < 0.05). Significant improvements in quality of life indices were also seen. At 1-month follow up, a sustained reduction in incontinence of wind was seen (0 episodes), with non-significant reductions of liquid and solid stool.

CONCLUSIONS

PTNS is a potentially efficacious, technically simple and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium- and long-term follow-up, and a larger randomised trial comparing PTNS with alternative treatments and placebo.

[Posterior tibial nerve stimulation in the management of overactive bladder: a prospective and controlled study]

The aim of this study was to evaluate the efficacy of the Posterior Tibial Nerve stimulation in women with overactivity bladder symptoms and the impact in the quality of life using the Overactivity Bladder Questionnaire (OABq).

METHODS

thirty seven women from female urology outpatient clinic of the Hospital das Clinicas de Campinas (HC/UNICAMP) were enrolled in this prospective, controlled and randomized clinical trial. The patients were randomly placed in one of two groups: TREATMENT GROUP: patients were submitted to tibial posterior nerve electrical stimulation (n=21) and Sham group: patients had electrodes placed without electricity (n = 16). After informed consent the patients underwent a physiotherapeutic evaluation, that included voiding diary and the overactivity bladder questionnaire (OABq). The treatment schedule included eight sessions of electrical stimulation in the posterior tibial nerve, twice a week.

RESULTS

there were significant changes in symptoms such as frequency and nocturia (p=0,003 and p=0,001). The urgency and quality of life was improved in both group after treatment.

CONCLUSION

The posterior tibial nerve electrical stimulation is an effective treatment in overactive bladder.