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Yildiz N, Celtek MA. Effects of Transcutaneous Tibial Nerve Stimulation in Women Refractory to and Never Used Pharmacological Agents for Idiopathic Overactive Bladder. Int Urogynecol J 2024; 35:571-578. [PMID: 38206337 DOI: 10.1007/s00192-023-05704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study is to compare the effectiveness of transcutaneous tibial nerve stimulation (TTNS) on quality of life (QoL) and clinical parameters related to incontinence in pharmacological agents (PhAs) naive and refractory women with idiopathic overactive bladder (iOAB). METHODS In this prospective nonrandomized clinical trial, women with resistance to PhAs were included in the first group (n=21), PhA-naive women were included in the second group (n=21). TTNS was performed 2 days a week, a total of 12 sessions for 6 weeks. Every session lasted 30 min. Women were evaluated for the severity of incontinence (Pad test), 3-day voiding diary (voiding frequency, nocturia, incontinence episodes, and number of pads), symptom severity (Overactive Bladder Questionnaire-V8), quality of life (Incontinence Impact Questionnaire-7), treatment satisfaction, positive response, and cure-improvement rates. RESULTS A statistically significant improvement was found in all parameters for each group at the 6th week compared with the baseline values (p<0.05). It was found that the severity of incontinence, incontinence episodes, symptom severity, treatment satisfaction, and QoL parameters were significantly improved in PhA-naive group compared with the PhA-resistant group at the 6th week (p<0.05). There were no statistically significant differences in the frequency of voiding, nocturia, and number of pads between the two groups (p>0.05). Positive response rates, the primary outcome measure, were statistically significantly higher in the PhA-naive group than in the PhA-resistant group. CONCLUSIONS Although TTNS is more effective in PhA-naive women with iOAB, it appears to be an effective therapy that can also be used in the management of PhA-resistant women with iOAB.
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Affiliation(s)
- Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, 20160, Denizli, Turkey.
| | - Merve Arbay Celtek
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, 20160, Denizli, Turkey
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Viallard L, Voiry C, Maze S, Fontaine S, Kerdraon J, Bonan I, Peyronnet B. [Uroflowmetry: A follow-up tool for neurogenic bladder patients treated by transcutaneous tibial posterior stimulation?]. Prog Urol 2023; 33:421-426. [PMID: 36922295 DOI: 10.1016/j.purol.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 02/10/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Neurogenic bladders can suffer from overactivity, underactivity or dyssynergia depending on the level of the initial lesion. These symptoms can lead to severe alterations of the upper urinary tract. One of the first-line treatments is the transcutaneous tibial posterior stimulation (TTNS), which was demonstrated to be efficient on urodynamics. But it is an invasive, expensive and sometimes not patient-accepted examination, contrary to the uroflowmetry. The aim of this study is to assess the feasibility of a follow-up with a uroflowmetry when treated by TTNS and show that the maximum flow rate increased after treatment, displaying a better detrusor contraction. METHODS In total, 38 patients with neurogenic bladder undergoing a 12-weeks TTNS treatment and with 2 uroflowmetries interpretable before and after treatment were included. The maximum flow rate (Qmax), the urinated volume and the post-void residual (PVR) were retrieved from the uroflowmetry, and the USP-score and the urinary discomfort were asked at each appointment. RESULTS Qmax is increased from 17,53ml/s to 18,26ml/s, as well as the PVR (from 76,97ml to 79,16ml). Urinated volume is decreased from 241,4ml to 193,66ml. Patients feel enhanced after TTNS according to the decrease in the USP-score and the urinary discomfort scale. CONCLUSION The increase of the cystomanometric capacity and the delay of the detrusor overactivity due to TTNS explains the reduction of the urinated volume and the increase of PVR. Increased Qmax might show a better voluntary bladder contraction, with a restraint due to the lack of abdominal pressure measurement during voiding.
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Affiliation(s)
- Lisa Viallard
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France; Université Rennes 1, 35000 Rennes, France.
| | - Caroline Voiry
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France
| | - Stéphanie Maze
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France
| | - Sylvie Fontaine
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France
| | - Jacques Kerdraon
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France; Centre de rééducation de Kerpape, 56270 Ploemeur, France
| | - Isabelle Bonan
- Service de médecine physique et rééducation, CHU de Rennes, 35000 Rennes, France; Université Rennes 1, 35000 Rennes, France
| | - Benoît Peyronnet
- Université Rennes 1, 35000 Rennes, France; Service d'urologie, CHU de Rennes, 35000 Rennes, France; Équipe thématique INPHY CIC 1414, Inserm UMR 991, CHU de Rennes, 35000 Rennes, France
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Yildiz N, Sonmez R. Transcutaneous medial plantar nerve stimulation in women with idiopathic overactive bladder. Investig Clin Urol 2023; 64:395-403. [PMID: 37417565 DOI: 10.4111/icu.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/10/2023] [Accepted: 04/10/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB). MATERIALS AND METHODS Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week. RESULTS Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week. CONCLUSIONS T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS.
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Affiliation(s)
- Necmettin Yildiz
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkiye.
| | - Rafet Sonmez
- Department of Physical Medicine and Rehabilitation, Ministry of Health, Şırnak State Hospital, Denizli, Turkiye
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Li X, Zhou Z, Zhao H, Liao L, Li X. Efficacy of a novel wearable transcutaneous tibial nerve stimulation device on bladder reflex compared to implantable tibial nerve stimulation in cats. Int Urol Nephrol 2023; 55:853-859. [PMID: 36534220 PMCID: PMC9761023 DOI: 10.1007/s11255-022-03450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the efficacy of novel wearable transcutaneous tibial nerve stimulation (TTNS) device on bladder reflex in cats compared to implantable tibial nerve stimulation (ITNS). MATERIALS AND METHODS Two self-adhesive electrodes of the TTNS device were placed at the left leg, and ITNS was applied to stimulate the tibial nerve of the right leg, respectively. The intensity threshold (T) was defined as inducing observable toe movement. Multiple cystometrograms (CMGs) with normal saline (NS) infusion were performed to determine the inhibitory effects of TTNS and ITNS on the micturition reflex. RESULTS TTNS at 4 times T (4 T), 6 times T (6 T), and the maximum output current intensity 24 mA significantly increased the bladder capacity (BC) compared to the control level (8.70 ± 2.46 ml) (all p < 0.05); however, there was no statistical significance among the three intensities. At the same time, ITNS at 2 times T (2 T), 4 T, 6 T, and the current intension 24 mA could significantly increase the BC compared to the control level (all p < 0.05). Likewise, no significant difference was observed among the four intensities (p > 0.05). The T values of TTNS were higher than those of ITNS (p = 0.02). The inhibitory effects of TTNS and ITNS revealed no significant difference at their respective 2 T, 4 T, 6 T, and 24 mA. Neither TTNS nor ITNS changed the contraction duration and amplitude (all p > 0.05). CONCLUSIONS TTNS was effective in increasing BC. The non-invasive neuromodulation technique could achieve a similar effect as ITNS.
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Affiliation(s)
- Xunhua Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhonghan Zhou
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hui Zhao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China.
- University of Health and Rehabilitation Sciences, Qingdao, China.
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
| | - Xing Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China.
- University of Health and Rehabilitation Sciences, Qingdao, China.
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Effect of Electroacupuncture Added to Pelvic Floor Muscle Training in Women with Stress Urinary Incontinence: A Randomized Clinical Trial. Eur Urol Focus 2022; 9:352-360. [PMID: 36420937 DOI: 10.1016/j.euf.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/18/2022] [Accepted: 10/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is a first-line conservative therapy for stress urinary incontinence (SUI). Electroacupuncture (EA) has been used to treat SUI recently. OBJECTIVE To compare the effectiveness of PFMT + EA versus PFMT + sham EA for SUI in women. DESIGN, SETTING, AND PARTICIPANTS A prospective, multicenter, randomized, controlled clinical trial was conducted at four hospitals in China involving 304 women with SUI from May 20, 2014 to November 21, 2017. Data were analyzed from April 20 to December 21, 2018. INTERVENTION Participants were randomized to receive 8 wk of PFMT+ EA (n = 154) or PFMT + sham EA (n = 150). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the change in the amount of urine leakage measured on a 1-hr pad test. Student's t test, the χ2 test, and the Wilcoxon rank-sum test were used for data analysis. RESULTS AND LIMITATIONS Among the 304 participants randomized, 286 completed the study. The mean age was 57.6 yr (standard deviation [SD] 8.9) for the PFMT + sham EA group and 57.2 yr (SD 9.1) for the PFMT + EA group. The mean urine leakage at baseline was 13.6 g for the PFMT + sham EA group and 13.9 g for the PFMT + EA group. After the 8-wk intervention, the PFMT + EA group had a greater decrease in mean urine leakage (-9.8 g) than the PFMT + sham EA group (-5.8 g) with a mean difference of 4.0 g (95% confidence interval [CI] 0.8-7.2). Significantly more patients experienced a ≥50% reduction in urine leakage and the mean number of incontinence episodes in 24 h in the PFMT + EA group than in the PFMT + sham EA group (26.3%, 95%CI 15.8-36.8%). The PFMT + EA group experienced better improvement in participant-reported SUI severity at 6 wk (p < 0.001) and 8 wk (p < 0.001) and self-evaluated therapeutic effects at 2-32 wk (p < 0.001) after the intervention. Lack of measurement of the amount of urine leakage during follow-up is a limitation. CONCLUSIONS In this randomized clinical trial, 8-wk combined treatment with PFMT + EA led to a greater improvement in SUI symptoms and better outcomes than with PFMT + sham EA. PATIENT SUMMARY We evaluated the effectiveness and safety of pelvic floor muscle training combined with electroacupuncture for stress urinary incontinence in women, Our results show that this is a promising therapeutic approach for the treatment of stress urinary incontinence.
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Sayner AM, Rogers F, Tran J, Jovanovic E, Henningham L, Nahon I. Transcutaneous Tibial Nerve Stimulation in the Management of Overactive Bladder: A Scoping Review. Neuromodulation 2022; 25:1086-1096. [DOI: 10.1016/j.neurom.2022.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 12/28/2022]
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Li X, Li X, Zhou Z, Zhao H, Liao L. Feasibility of a Transcutaneous Tibial Nerve Stimulation Device Use in Overactive Bladder Patients: A Pilot Study From a Single Tertiary Care Center. Front Neurol 2022; 13:872200. [PMID: 35528738 PMCID: PMC9074788 DOI: 10.3389/fneur.2022.872200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo evaluate the preliminary efficacy, safety, and acceptability of a transcutaneous tibial nerve stimulation (TTNS) device in overactive bladder (OAB) patients.MethodsTwenty OAB patients who failed with conservative treatments were recruited consecutively. All patients received 60 min of daily unilateral stimulation for 4 weeks using a smart wearable transcutaneous tibial nerve stimulation device and the stimulations were at 20 Hz frequency, 200 μs pulse width. OAB symptoms were observed at baseline and week 4, using a 3-days voiding diary, the overactive bladder symptom score (OABSS), the perception of bladder condition (PPBC), and the American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL). Urodynamic characteristics were measured to determine the pilot efficacy of the device during the treatment comparing the baseline parameters to the post-treatment parameters.ResultsAmong the patients, 15 cases were OAB-dry and five cases were OAB-wet. All patients were evaluated at the end of the study and no significant side effects were found during the treatment. The daily micturition frequency and the number of incontinence episodes per day were reduced from 15.10 ± 1.61 to 12.00 ± 4.56, and 3.20 ± 0.80 to 0.47 ± 0.38, respectively. The mean voiding volume was increased from 130.10 ± 53.07 to 157.30 ± 66.95 mL. The OABSS, AUA-SI-QoL, and PPBC were reduced from 9.35 ± 1.39 to 5.9 ± 2.36, 5.70 ± 0.47 to 3.85 ± 1.04, and 5.70 ± 0.47 to 4.35 ± 0.86, respectively. The first sensation of bladder filling (1st SBF), maximal bladder capacity (MBC), and mean compliance were increased from 87.50 (60.00–167.50) to 150.00 (104.00–211.30) mL, 175.00 (120.30–354.00) to 255.00 (151.50–491.50) mL, and 36.67 (12.44–39.69) to 40.00 (20.00–52.50) mL/cmH2O, respectively. The maximum detrusor pressure (Pdet. max) was reduced from 14.50 (5.00–35.25) to 11.00 (6.00–20.00) cmH2O.ConclusionThe preliminary results demonstrated that the TTNS device was safe, effective, and acceptable to use in OAB patients, but the results need to be substantiated by conducting more randomized controlled studies further.
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Affiliation(s)
- Xunhua Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zhonghan Zhou
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hui Zhao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Limin Liao
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Liang Y, Liao L, Wan X, Li X, Li X, Wang Y. Inhibitory effects of a smartphone-controlled wearable transcutaneous tibial nerve stimulation device on bladder reflexes in anesthetized cats. Neurourol Urodyn 2022; 41:585-591. [PMID: 35066911 DOI: 10.1002/nau.24876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To explore the inhibitory effects of a novel, smartphone-controlled, and wearable tibial nerve stimulation device on nonnociceptive and nociceptive bladder reflexes in anesthetized cats and to compare the stimulus results of two current waveforms outputted by this new stimulator. MATERIALS AND METHODS A novel, intelligent tibial nerve stimulator was put on the ankles of 14 cats and controlled by a mobile application. Cystometrograms (CMGs) were performed repeatedly by infusing 0.9% normal saline (NS) and 0.5% acetic acid (AA) through a urethral catheter. Inhibitory effects were explored by measuring the bladder capacity (BC) in two areas: (1) on nonnociceptive bladder reflex (infused with NS) and on nociceptive bladder reflex (filled with AA to induce overactive bladder [OAB] model); and (2) under the stimulation of two different current waveforms (waveforms A and B). RESULTS In Group 1, the BC of AA-induced OAB (41.48 ± 8.40%) was significantly different compared with the capacity of a NS-infused bladder (104.89 ± 1.32%, p < 0.05). Both NS-filled (151.35 ± 5.71%, p < 0.05) and AA-instilled (71.41 ± 9.34%, p < 0.05) bladder volumes significantly increased after tibial nerve stimulation (TNS). In Group 2, the BC increased to 166.18 ± 15.17% (p = 0.026) and 127.64 ± 13.00% (p = 0.239), respectively, after TNS with waveforms A and B current. CONCLUSIONS Results revealed that this novel, smartphone-based, wearable, and wireless tibial nerve stimulation system could inhibit the micturition reflex on physiological condition, serving as a potential option for OAB treatment. In addition, the waveforms of stimulation current had an important influence on the effects of TNS.
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Affiliation(s)
- Yanan Liang
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China
| | - Limin Liao
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China.,Department of Urology, Capital Medical University, Beijing, China
| | - Xiaoping Wan
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China
| | - Xing Li
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China
| | - Xunhua Li
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China
| | - Yiming Wang
- School of Rehabilitation, Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China
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Alkis O, Sevim M, Güven Kartal İ, Baser A, İbrahim İvelik H, Aras B. Comparison of transcutaneous tibial nerve stimulation (TTNS) protocols for women with refractory overactive bladder (OAB): A prospective randomised trial. Int J Clin Pract 2021; 75:e14342. [PMID: 33966335 DOI: 10.1111/ijcp.14342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. METHODS A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30 minutes for 12 weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. RESULTS Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group 1 and group 2 (P < .001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12 weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. CONCLUSION TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week. What's known TTNS is one of the effective alternative treatments in resistant OAB treatment. What's new As the number of sessions is increased in TTNS treatment, the success of the treatment can increase.
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Affiliation(s)
- Okan Alkis
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Mehmet Sevim
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - İbrahim Güven Kartal
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Aykut Baser
- Department of Urology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Halil İbrahim İvelik
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Bekir Aras
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
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Polat Dunya C, Tülek Z, Kürtüncü M, Gündüz T, Panicker JN, Eraksoy M. Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder. Neurourol Urodyn 2021; 40:1661-1669. [PMID: 34174117 DOI: 10.1002/nau.24733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/15/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023]
Abstract
AIMS Sexual dysfunction (SD) is common in female patients with multiple sclerosis (MS) reporting overactive bladder (OAB) symptoms. The aim of the study was to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on SD in female patients with MS reporting OAB symptoms. METHODS Patients with overactive bladder and SD were allocated to receive TTNS or PFMT daily. Overactive bladder symptoms, sexual functions, and sexual quality of life were assessed at baseline and 6th weeks. Female Sexual Function Index (FSFI), Overactive Bladder Questionnaire (OABv-8), and Sexual Quality of Life-Female (SQoL-F) questionnaires were used. RESULTS Thirty patients (TTNS = 10, PFMT = 20) were included in the study. Compared to baseline, total FSFIOABv-8, and SQoL-F scores improved in both TTNS (p = 0.005, p = 0.011, p = 0.444, respectively) and PFMT (p = 0.002, p = 0.001, p = 0.001, respectively) groups. Between-group comparisons did not show any significant differences. CONCLUSION This study demonstrates the efficacy of both TTNS and PFMT for improving sexual function in female MS patients with OAB symptoms, but did not show superiority of any particular method. Further studies are required to investigate the differences between these two non-invasive methods.
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Affiliation(s)
- Cansu Polat Dunya
- Division of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Zeliha Tülek
- Division of Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Booth J, Aucott L, Cotton S, Davis B, Fenocchi L, Goodman C, Hagen S, Harari D, Lawrence M, Lowndes A, Macaulay L, MacLennan G, Mason H, McClurg D, Norrie J, Norton C, O'Dolan C, Skelton D, Surr C, Treweek S. Tibial nerve stimulation compared with sham to reduce incontinence in care home residents: ELECTRIC RCT. Health Technol Assess 2021; 25:1-110. [PMID: 34167637 PMCID: PMC8273680 DOI: 10.3310/hta25410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary incontinence is prevalent in nursing and residential care homes, and has a profound impact on residents' dignity and quality of life. Treatment options are limited in these care contexts and care homes predominantly use absorbent pads to contain incontinence, rather than actively treat it. Transcutaneous posterior tibial nerve stimulation is a non-invasive, safe, low-cost intervention that is effective in reducing urinary incontinence in adults. OBJECTIVE To determine the clinical effectiveness of transcutaneous posterior tibial nerve stimulation to treat urinary incontinence in care home residents and to determine the associated costs of the treatment. DESIGN A multicentre, pragmatic, participant and outcome assessor-blind, randomised placebo-controlled trial. SETTING A total of 37 UK residential and nursing care homes. PARTICIPANTS Care home residents with at least weekly urinary incontinence that is contained using absorbent pads and who are able to use a toilet/toilet aid with or without assistance. INTERVENTIONS Residents were randomised (1 : 1) to receive 12 30-minute sessions of transcutaneous posterior tibial nerve stimulation or sham stimulation over a 6-week period. MAIN OUTCOME MEASURES Primary outcome - change in volume of urine leaked over a 24-hour period at 6 weeks. Secondary outcomes - number of pads used, Perception of Bladder Condition, toileting skills, quality of life and resource use. RESULTS A total of 408 residents were randomised (transcutaneous posterior tibial nerve stimulation, n = 197; sham stimulation, n = 209); two exclusions occurred post randomisation. Primary outcome data were available for 345 (85%) residents (transcutaneous posterior tibial nerve stimulation, n = 167; sham stimulation, n = 178). Adherence to the intervention protocol was as follows: 78% of the transcutaneous posterior tibial nerve stimulation group and 71% of the sham group received the correct stimulation. Primary intention-to-treat adjusted analysis indicated a mean change of -5 ml (standard deviation 362 ml) urine leakage from baseline in the transcutaneous posterior tibial nerve stimulation group and -66 ml (standard deviation 394 ml) urine leakage in the sham group, which was a statistically significant, but not clinically important, between-group difference of 68-ml urine leakage (95% confidence interval 0 to 136 ml; p = 0.05) in favour of the sham group. Sensitivity analysis supported the primary analysis. No meaningful differences were detected in any of the secondary outcomes. No serious adverse events related to transcutaneous posterior tibial nerve stimulation were reported. Economic evaluation assessed the resources used. The training and support costs for the staff to deliver the intervention were estimated at £121.03 per staff member. Estimated costs for delivery of transcutaneous posterior tibial nerve stimulation during the trial were £81.20 per participant. No significant difference was found between participants' scores over time, or between transcutaneous posterior tibial nerve stimulation and sham groups at any time point, for resident or proxy quality-of-life measures. CONCLUSIONS The ELECTRIC (ELECtric Tibial nerve stimulation to Reduce Incontinence in Care homes) trial showed, in the care home context (with a high proportion of residents with poor cognitive capacity and limited independent mobility), that transcutaneous posterior tibial nerve stimulation was not effective in reducing urinary incontinence. No economic case for transcutaneous posterior tibial nerve stimulation was made by the cost-consequences analysis; however, the positive reception of learning about urinary incontinence for care home staff supports a case for routine education in this care context. LIMITATIONS Completing 24-hour pad collections was challenging for care home staff, resulting in some missing primary outcome data. FUTURE WORK Research should investigate transcutaneous posterior tibial nerve stimulation in residents with urgency urinary incontinence to determine whether or not targeted stimulation is effective. Research should evaluate the effects of continence training for staff on continence care in care homes. TRIAL REGISTRATION Current Controlled Trials ISRCTN98415244 and ClinicalTrials.gov NCT03248362. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanne Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Bridget Davis
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Linda Fenocchi
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Danielle Harari
- Department of Geriatric Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maggie Lawrence
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Lisa Macaulay
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Helen Mason
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - John Norrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Catriona O'Dolan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dawn Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Claire Surr
- School of Health and Community Studies, Leeds Beckett University, Leeds, UK
| | - Shaun Treweek
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
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12
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Payne SC, Wiedmann NM, Eiber CD, Wong AW, Senn P, Osborne PB, Keast JR, Fallon JB. Recording of Electrically Evoked Neural Activity and Bladder Pressure Responses in Awake Rats Chronically Implanted With a Pelvic Nerve Array. Front Neurosci 2020; 14:619275. [PMID: 33390899 PMCID: PMC7773906 DOI: 10.3389/fnins.2020.619275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 01/16/2023] Open
Abstract
Bioelectronic medical devices are well established and widely used in the treatment of urological dysfunction. Approved targets include the sacral S3 spinal root and posterior tibial nerve, but an alternate target is the group of pelvic splanchnic nerves, as these contain sacral visceral sensory and autonomic motor pathways that coordinate storage and voiding functions of the bladder. Here, we developed a device suitable for long-term use in an awake rat model to study electrical neuromodulation of the pelvic nerve (homolog of the human pelvic splanchnic nerves). In male Sprague-Dawley rats, custom planar four-electrode arrays were implanted over the distal end of the pelvic nerve, close to the major pelvic ganglion. Electrically evoked compound action potentials (ECAPs) were reliably detected under anesthesia and in chronically implanted, awake rats up to 8 weeks post-surgery. ECAP waveforms showed three peaks, with latencies that suggested electrical stimulation activated several subpopulations of myelinated A-fiber and unmyelinated C-fiber axons. Chronic implantation of the array did not impact on voiding evoked in awake rats by continuous cystometry, where void parameters were comparable to those published in naïve rats. Electrical stimulation with chronically implanted arrays also induced two classes of bladder pressure responses detected by continuous flow cystometry in awake rats: voiding contractions and non-voiding contractions. No evidence of tissue pathology produced by chronically implanted arrays was detected by immunohistochemical visualization of markers for neuronal injury or noxious spinal cord activation. These results demonstrate a rat pelvic nerve electrode array that can be used for preclinical development of closed loop neuromodulation devices targeting the pelvic nerve as a therapy for neuro-urological dysfunction.
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Affiliation(s)
- Sophie C Payne
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole M Wiedmann
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Calvin D Eiber
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Agnes W Wong
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Philipp Senn
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Melbourne, VIC, Australia
| | - Peregrine B Osborne
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - Janet R Keast
- Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, VIC, Australia
| | - James B Fallon
- Bionics Institute, Fitzroy, VIC, Australia.,Medical Bionics Department, University of Melbourne, Melbourne, VIC, Australia.,Department of Otolaryngology, University of Melbourne, Melbourne, VIC, Australia
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13
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Araujo TG, Schmidt AP, Sanches PRS, Silva Junior DP, Rieder CRM, Ramos JGL. Transcutaneous tibial nerve home stimulation for overactive bladder in women with Parkinson's disease: A randomized clinical trial. Neurourol Urodyn 2020; 40:538-548. [PMID: 33326648 DOI: 10.1002/nau.24595] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/13/2020] [Accepted: 11/28/2020] [Indexed: 01/13/2023]
Abstract
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).
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Affiliation(s)
- Tatiane G Araujo
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Adriana P Schmidt
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Paulo R S Sanches
- Biomedical Engineering Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Danton P Silva Junior
- Biomedical Engineering Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos R M Rieder
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Neurology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - José G L Ramos
- School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.,Urogynecology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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14
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Polat Dunya C, Tulek Z, Kürtüncü M, Panicker JN, Eraksoy M. Effectiveness of the transcutaneous tibial nerve stimulation and pelvic floor muscle training with biofeedback in women with multiple sclerosis for the management of overactive bladder. Mult Scler 2020; 27:621-629. [DOI: 10.1177/1352458520926666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB ( p = 0.0001, p = 0.0001), Qualiveen-siup ( p = 0.0001, p = 0.0001), Qualiveen-QoL ( p = 0.002, p = 0.006), PVR ( p = 0.0001, p = 0.21), frequency ( p = 0.0001, p = 0.69), nocturia ( p = 0.0001, p = 0.19), urgency ( p = 0.0001, p = 0.0001), and urge incontinence ( p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency ( p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.
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Affiliation(s)
- Cansu Polat Dunya
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeliha Tulek
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Mefkure Eraksoy
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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15
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Abstract
PURPOSE OF REVIEW The present review highlights regenerative electrical stimulation (RES) as potential future treatment options for patients with nerve injuries leading to urological dysfunction, such as urinary incontinence, voiding dysfunction or erectile dysfunction. Additionally, it will highlight the mechanism of nerve injury and regeneration as well as similarities and differences between RES and current electrical stimulation treatments in urology, functional electrical stimulation (FES) and neuromodulation. RECENT FINDINGS It has been demonstrated that RES upregulates brain-derived neurotrophic factor (BDNF) and its receptor to facilitate neuroregeneration, facilitating accurate reinnervation of muscles by motoneurons. Further, RES upregulates growth factors in glial cells. Within the past 2 years, RES of the pudendal nerve upregulated BDNF in Onuf's nucleus, the cell bodies of motoneurons that course through the pudendal nerve and accelerated functional recovery in an animal model of stress urinary incontinence. Additionally, electrical stimulation of the vaginal tissue in an animal model of stress urinary incontinence accelerated functional recovery. SUMMARY RES has great potential but future research is needed to expand the potential beneficial effects of RES in the field of urology.
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16
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Do Failure of Posterior Tibial Nerve Stimulation Precludes to Use Sacral Neuromodulation in Patient With Overactive Bladder? Int Neurourol J 2020; 23:287-293. [PMID: 31905275 PMCID: PMC6944783 DOI: 10.5213/inj.1938118.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/29/2019] [Indexed: 01/27/2023] Open
Abstract
Purpose To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB). Methods A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1. Results Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P=0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P=0.18). There was no other parameter significantly associated with response to SNM Conclusions SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.
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17
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Boaretto JA, Mesquita CQ, Lima AC, Prearo LC, Girão MJBC, Sartori MGF. Comparação entre oxibutinina, eletroestimulação do nervo tibial posterior e exercícios perineais no tratamento da síndrome da bexiga hiperativa. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17020026022019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivou-se avaliar a eficácia dos exercícios perineais, da eletroestimulação transcutânea do nervo tibial posterior (ETNTP) e da oxibutinina em mulheres com síndrome da bexiga hiperativa, que é a segunda causa mais comum de incontinência urinária, com sintomas urinários extremamente incômodos que prejudicam a qualidade de vida. Foram randomizadas 65 mulheres, das quais 57 completaram o tratamento. Formaram-se três grupos: o de exercícios perineais, ETNTP e o grupo controle, que utilizou oxibutinina. Os exercícios foram realizados em grupo, nas posições em pé, supino e sentado, duas vezes por semana, com duração de 30 minutos cada sessão, totalizando 12 sessões. Na ETNTP utilizou-se eletrodo transcutâneo posicionado em maléolo medial e outro 10cm acima, com frequência de 10Hz e largura de pulso de 200 microssegundos, por 30 minutos, duas vezes por semana, totalizando 12 sessões. Na medicação as pacientes receberam oxibutinina de 10mg/dia de liberação imediata divididos e duas doses de 5mg/dia, durante 12 semanas consecutivas. Antes e depois dos tratamentos, as pacientes passaram por uma avaliação composta pela análise do diário miccional, avaliação funcional do assoalho pélvico e aplicação de questionário de qualidade de vida OAB-V8. Houve redução da incontinência de urgência em 50%, 70,5% e 41% nos grupos de exercício, ETNTP e oxibutinina, respectivamente, com significância estatística somente da eletroestimulação. As três modalidades de tratamento foram eficazes na melhora da qualidade de vida para a terapêutica em curto prazo, estatisticamente semelhantes entre si.
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18
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Ramírez-García I, Blanco-Ratto L, Kauffmann S, Carralero-Martínez A, Sánchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: Randomized control trial. Neurourol Urodyn 2018; 38:261-268. [DOI: 10.1002/nau.23843] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/10/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Inés Ramírez-García
- RAPbarcelona Physiotherapy Clinical Center; Barcelona Spain
- Blanquerna School of Health Science; Ramon Llull University; Barcelona Spain
| | | | | | | | - Emília Sánchez
- Blanquerna School of Health Science; Ramon Llull University; Barcelona Spain
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19
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Zimmerman LL, Gupta P, O'Gara F, Langhals NB, Berger MB, Bruns TM. Transcutaneous Electrical Nerve Stimulation to Improve Female Sexual Dysfunction Symptoms: A Pilot Study. Neuromodulation 2018; 21:707-713. [PMID: 30247794 DOI: 10.1111/ner.12846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/11/2018] [Accepted: 07/15/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To perform a pilot study using transcutaneous electrical nerve stimulation (TENS) on the dorsal genital nerve and the posterior tibial nerve for improving symptoms of female sexual dysfunction (FSD) in women without bladder problems. We hypothesize that this therapy will be effective at improving genital arousal deficits. MATERIALS AND METHODS Nine women with general FSD completed the study. Subjects received 12 sessions of transcutaneous dorsal genital nerve stimulation (DGNS; n = 6) or posterior tibial nerve stimulation (PTNS; n = 3). Stimulation was delivered for 30 min at 20 Hz. Sexual functioning was evaluated with the female sexual functioning index (FSFI), and surveys were also given on general health, urological functioning, and the Patients' Global Impression of Change (PGIC) after treatment. Surveys were given before treatment (baseline), after 6 and 12 weeks of treatment, and 6 weeks after the completion of stimulation sessions. RESULTS The average total FSFI score across all subjects significantly increased from 15.3 ± 4.8 at baseline to 20.3 ± 7.8 after six sessions, 21.7 ± 7.5 after 12 sessions, and 21.3 ± 7.1 at study completion (p < 0.05 for all time points). Increases were observed in both DGNS and PTNS subjects. Significant FSFI increases were seen in the subdomains of lubrication, arousal, and orgasm, each of which is related to genital arousal. Bladder and general health surveys did not change across the study. PGIC had a significant increase. CONCLUSIONS This study provides evidence that transcutaneous stimulation of peripheral nerves has the potential to be a valuable therapeutic tool for women with FSD.
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Affiliation(s)
- Lauren L Zimmerman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Florence O'Gara
- Sexual Health Counseling, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas B Langhals
- Department of Surgery, Plastic Surgery Section, University of Michigan, Ann Arbor, MI, USA
| | - Mitchell B Berger
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.,Obstetrics & Gynecology, Main Line Health, Wynnewood, PA, USA
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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20
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Leroux PA, Brassart E, Lebdai S, Azzouzi AR, Bigot P, Carrouget J. Transcutaneous tibial nerve stimulation: 2 years follow-up outcomes in the management of anticholinergic refractory overactive bladder. World J Urol 2018; 36:1455-1460. [DOI: 10.1007/s00345-018-2296-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/05/2018] [Indexed: 01/04/2023] Open
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21
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Hentzen C, Haddad R, Sheikh Ismaël S, Chesnel C, Robain G, Amarenco G. Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults. Eur Geriatr Med 2018; 9:249-253. [PMID: 34654250 DOI: 10.1007/s41999-017-0013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The main objective of this retrospective study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment. METHODS All patients aged over 65 years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in two neuro-urology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e., purchase of the device between 3 and 6 months). RESULTS A total of 264 patients were included (mean age 74.1 ± 6.5 years; 63.3% of women), of whom 53% had neurogenic OAB. Urinary incontinence was reported by 83.7% of patients and DO was found on urodynamic studies in 154 patients. The overall efficacy of TPTNS was 45.1%. None of the tested factors were significantly predictive of efficacy, especially age (≥ 75 years, p = 0.62), associated stress urinary incontinence (p = 0.69) and presence of DO (p = 0.60), whether neurogenic or not. CONCLUSION TPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. This treatment seems to be a good alternative to antimuscarinics against overactive bladder in older adults.
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Affiliation(s)
- C Hentzen
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France. .,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France.
| | - R Haddad
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - S Sheikh Ismaël
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - C Chesnel
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Robain
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Amarenco
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
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22
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Sharan E, Hunter K, Hassouna M, Yoo PB. Characterizing the transcutaneous electrical recruitment of lower leg afferents in healthy adults: implications for non-invasive treatment of overactive bladder. BMC Urol 2018; 18:10. [PMID: 29439703 PMCID: PMC5812114 DOI: 10.1186/s12894-018-0322-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND As a potential new treatment for overactive bladder (OAB), we investigated the feasibility of non-invasively activating multiple nerve targets in the lower leg. METHODS In healthy participants, surface electrical stimulation (frequency = 20 Hz, pulse width = 200 μs) was used to target the tibial nerve, saphenous nerve, medial plantar nerve, and lateral plantar nerve. At each location, the stimulation amplitude was increased to define the thresholds for evoking (1) cutaneous sensation, (2) target nerve recruitment and (3) maximum tolerance. RESULTS All participants were able to tolerate stimulation amplitudes that were 2.1 ± 0.2 (range = 2.0 to 2.4) times the threshold for activating the target nerve. CONCLUSIONS Non-invasive electrical stimulation can activate neural targets at levels that are consistent with evoking bladder-inhibitory reflex mechanisms. Further work is needed to test the clinical effects of stimulating one or more neural targets in OAB patients.
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Affiliation(s)
- Eshani Sharan
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Room 407, Toronto, ON M5S 3G9 Canada
| | - Kelly Hunter
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Room 407, Toronto, ON M5S 3G9 Canada
| | - Magdy Hassouna
- Division of Urology, Toronto Western Hospital, Toronto, ON Canada
| | - Paul B. Yoo
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College Street, Room 407, Toronto, ON M5S 3G9 Canada
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON Canada
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[Outcomes of transcutaneous posterior tibial nerve stimulation for overactive bladder in diabetic patients]. Prog Urol 2017; 27:1091-1097. [PMID: 28964687 DOI: 10.1016/j.purol.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/30/2017] [Accepted: 08/17/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Treatment with transcutaneous posterior tibial neurostimulation (NTPT) has been shown to be effective in the treatment of overactive bladder (OAB), but its outcomes in diabetic patients have never been assessed. The aim of this study was to compare the efficacy of NTPT in diabetic OAB patients and in OAB patients without diabetes. METHODS A single-center prospective study included all patients treated with NTPT for lower urinary tract storage symptoms between 2012 and 2016. The primary endpoint was symptoms improvement≥50% assessed using a Visual Analog Scale (VAS) two months after starting NTPT. Treatment consisted in a daily 20-minute NTPT single-session. The secondary endpoints were lower urinary tract symptoms reported by bladder diary, the Urinary Symptom Profile, the impact on mood and on daily activities. RESULTS Seventy-one patients were included, 10 of whom were diabetic. The efficacy rate (EVA>50%) was not significantly different in the diabetic group (70% vs. 44.1%, P=0.17), like the mean EVA efficacy was similar in both groups (4/10 vs. 4/10, P=0.98). OAB USP sub-score diminished significantly in both groups at 2 months (-3 points in the diabetic group; -1.9 points in the non-diabetic group; P=0.03 and P<0.0001, respectively). There was no significant difference between the groups, except for the rate of patients who stopped treatment at 6 months, higher in diabetic patients (100% vs. 63.5%, P=0.04). CONCLUSION The functional outcomes of NTPT appear to be similar in the treatment of OAB in diabetic patients and in non-diabetic patients. LEVEL OF EVIDENCE 4.
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An Enhanced Method of Transcutaneously Stimulating the Tibial Nerve for the Treatment of Overactive Bladder. Ann Biomed Eng 2017; 45:2605-2613. [PMID: 28849398 DOI: 10.1007/s10439-017-1907-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) can be used to electrically stimulate the tibial nerve for the purpose of treating overactive bladder. Although clinical benefits can be achieved, the overall therapeutic efficacy of TENS is limited. Inconsistent activation of the intended neural target and co-activation of cutaneous sensory fibers are considered key limiting factors. In this study, we propose a novel approach that combines TENS with an implanted, electrically-conductive nerve cuff to reduce the stimulation amplitude needed to activate the tibial nerve. This enhanced version of TENS (called eTENS) was designed using a computational model of the rat tibial nerve and subsequently tested in anesthetized rats. Our computational model showed that eTENS can reduce the nerve activation threshold by a factor of up to 2.6. Similar effects were also achieved by in vivo experiments (1.4 ± 0.1-fold decrease, n = 5). Among various design parameters, spatial alignment between the surface electrode and the nerve cuff was identified as an important factor. Our results show that eTENS can improve the selective activation of the rat tibial nerve, but further work is needed to evaluate its use in clinical therapies.
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Abulseoud A, Moussa A, Abdelfattah G, Ibrahim I, Saba E, Hassouna M. Transcutaneous posterior tibial nerve electrostimulation with low dose trospium chloride: Could it be used as a second line treatment of overactive bladder in females. Neurourol Urodyn 2017; 37:842-848. [PMID: 28792105 DOI: 10.1002/nau.23361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/22/2017] [Indexed: 11/06/2022]
Abstract
AIM To evaluate the effect of adding low dose trospium chloride with transcutaneous posterior tibial nerve stimulation (TPTNS) in the treatment of overactive bladder (OAB) in females after failure of behavioral therapy. METHODS We randomized 30 women with OAB, in two groups: G I received 30 min TPTNS, three times a week; GII received TPTNS plus 20 mg trospium chloride daily. OAB Symptom Score questionnaire (OABSS), Incontinence Impact Questionnaire-short form 7 (IIQ-7), 3 day voiding diary and urodynamics at weeks 0 and 8 were evaluated. RESULTS The groups were similar before treatment. Eight weeks after treatment, the mean OABSS decreased significantly to 8.53 ± 1.30 for group II vs 10.0 ± 2.0 for GI (P < 0.024). The mean IIQ-7 score decreased significantly to 51.86 ± 17.26 in group I vs 31.99 ± 9.26 in group II (P < 0.001). Before treatment, 11 (73.3%) and 4 (26.7%) patients in each group had moderate and poor quality of life (QoL), respectively. After treatment, 6 (40%) and 14 (93.3%) had good QoL, 7 (46.7%) and 1 (6.7%) had moderate QoL in GI and GII, respectively. Two (13.3%) patients in GI had poor QoL. The mean frequency was reduced to 8.60 ± 0.83 vs 10.60 ± 2.32 for GII and GI respectively (P = 0.006). The cystometric capacity increased from 263.40 ± 50.45 to 377.80 ± 112.92 mL (P = 0.001) for GII vs 250.13 ± 56.24 to 296.40 ± 99.0 mL (P = 0.026) for GI. CONCLUSION TPTNS combined with low dose trospium chloride proved to be more effective than TPTNS alone in the treatment of OAB in females.
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Affiliation(s)
- Amr Abulseoud
- Department of Urology, Alexandria University Hospital, Alexandria, Egypt
| | - Ahmed Moussa
- Department of Urology, Alexandria University Hospital, Alexandria, Egypt
| | - Gaber Abdelfattah
- Department of Urology, Alexandria University Hospital, Alexandria, Egypt
| | - Ibrahim Ibrahim
- Department of Physical Medicine, Rheumatology, and Rehabilitation, Alexandria University Hospital, Alexandria, Egypt
| | - Emmanuel Saba
- Department of Physical Medicine, Rheumatology, and Rehabilitation, Alexandria University Hospital, Alexandria, Egypt
| | - Mohamed Hassouna
- Department of Urology, Alexandria University Hospital, Alexandria, Egypt
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Booth J, Connelly L, Dickson S, Duncan F, Lawrence M. The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review. Neurourol Urodyn 2017; 37:528-541. [DOI: 10.1002/nau.23351] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/13/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Joanne Booth
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow UK
| | - Lesley Connelly
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow UK
| | - Sylvia Dickson
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow UK
| | - Fiona Duncan
- Scottish Government; Cancer Policy Team; Edinburgh Edinburgh UK
| | - Maggie Lawrence
- School of Health and Life Sciences; Glasgow Caledonian University; Glasgow UK
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Moazzam Z, Paquette J, Duke AR, Khodaparast N, Yoo PB. Feasibility of Long-term Tibial Nerve Stimulation Using a Multi-contact and Wirelessly Powered Neurostimulation System Implanted in Rats. Urology 2017; 102:61-67. [DOI: 10.1016/j.urology.2016.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 11/27/2022]
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Moazzam Z, Duke AR, Yoo PB. Inhibition and Excitation of Bladder Function by Tibial Nerve Stimulation Using a Wirelessly Powered Implant: An Acute Study in Anesthetized Cats. J Urol 2016; 196:926-33. [PMID: 27154823 DOI: 10.1016/j.juro.2016.04.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Tibial nerve stimulation is a minimally invasive neuromodulation treatment of overactive bladder. However, in addition to our limited understanding of the underlying mechanisms, there are also questions regarding the long-term delivery of tibial nerve stimulation therapy in patients. We aimed to characterize the effects of stimulation frequency using a wirelessly powered implantable stimulation device. METHODS AND MATERIALS Six α-chloralose anesthetized adult male cats were used in this study. A multicontact lead was surgically implanted subcutaneously in the hind limb and used to stimulate the tibial nerve. Using an isovolumetric bladder a short duration of electrical pulses was applied at amplitudes 3 times the motor threshold and at frequencies from 2 to 20 Hz. RESULTS Implant driven stimulation of the tibial nerve resulted in frequency dependent activation of bladder reflexes. Low frequency tibial nerve stimulation (2 Hz) consistently evoked excitatory responses (mean ± SE 32.9% ± 3.8%). In contrast, higher frequency tibial nerve stimulation (6 to 20 Hz) inhibited bladder function (overall mean 14.9% ± 2.4%). Although low foot motor thresholds were achieved at initial implantation (mean 0.83 ± 0.05 mA), a notable elevation in threshold amplitude was observed 5 hours after implantation. CONCLUSIONS To our knowledge this study provides the first evidence of frequency dependent modulation of bladder function in anesthetized cats. The inhibitory influence of tibial nerve stimulation at frequencies above 6 Hz transitioned to an excitatory effect at 2 Hz. Taken together these preclinical data support the feasibility of using a wirelessly powered implantable device to potentially modulate bladder function in patients.
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Affiliation(s)
- Zainab Moazzam
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | | | - Paul B Yoo
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada.
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Xu H, Liu B, Wu J, Du R, Liu X, Yu J, Liu Z. A Pilot Randomized Placebo Controlled Trial of Electroacupuncture for Women with Pure Stress Urinary Incontinence. PLoS One 2016; 11:e0150821. [PMID: 26960195 PMCID: PMC4784883 DOI: 10.1371/journal.pone.0150821] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acupuncture is a potential conservative therapy for women with stress urinary incontinence (SUI). There is limited evidence to support its effectiveness due to the poor quality of existing studies. METHODS We performed a pilot randomized, controlled trial to preliminarily assess the efficacy of electroacupuncture (EA) in women with pure SUI. A total of 80 women with pure SUI were randomly assigned to receive EA with deep needling at BL33 and BL35 (n = 40) or sham EA with non-penetrating needling at sham acupoints (n = 40) three sessions per week for 6 weeks. The women were followed for 24 weeks. The primary outcome was the change from baseline in the amount of urine leakage measured by a 1-hour pad test after 6 weeks. The secondary outcomes included the 72-hour incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, and patient self-evaluation of therapeutic effect. Adverse events (AEs) were monitored throughout the trial. RESULTS The median decrease from baseline of urine leakage measured by the 1-hour pad test was 2.5 g [interquartile range (IQR): 1.80-14.6 in the EA group, which was greater than the median decrease of 0.05 g (IQR: -2.80-+0.50) in the sham EA group after 6 weeks (p<0.01). The differences between groups in the decrease from baseline of 72-hour IEF became statistically significant at week 30 with a median decrease of 3.25 g (IQR: 1.25-5.69) in the EA group, and a median decrease of 1.00 g (IQR: -0.69-+2.88) in the sham EA group (p = 0.01). The participants in the EA group showed greater decreases in ICIQ-SF score and higher ratings in the help they received from the treatment than those in the sham EA group at weeks 6,18 and 30 (all p<0.05). No obvious AEs were observed in either group. CONCLUSION EA may effectively and safely relieve urinary incontinence symptoms and improve quality of life in women with pure SUI. EA demonstrated more than a placebo effect. Since this is a pilot study, results should be interpreted with caution. TRIAL REGISTRATION ClinicalTrials.gov NCT02445573.
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Affiliation(s)
- Huanfang Xu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baoyan Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiani Wu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruosang Du
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxu Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jinna Yu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of acupuncture and moxibustion, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- * E-mail:
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The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum toxin? Curr Opin Urol 2016; 25:305-10. [PMID: 26049873 DOI: 10.1097/mou.0000000000000180] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW We have reviewed the evidence published on botulinum toxin A (BoNT/A), percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS) in the management of overactive bladder (OAB). RECENT FINDINGS BoNT/A is effective irrespectively of the number of previous anticholinergic treatments and of the reason for failure. Doses up to 360U 3-monthly are well tolerated. BoNT/A is well tolerated and effective also in the pediatric population. Bladder instillation of liposome encapsulated BoNT/A is a new approach, deserving further research. When using PTNS, motor response from the electrical stimulus is not required, a sensory response suffices. PTNS has a lasting effect compared to oxybutynin alone. SNS is superior to standard medical treatment but the combination of SNS and anticholinergics is more effective than anticholinergic alone. SUMMARY The evidence published in the last 18 months has increased the level of evidence on safety and effectiveness of BoNT/A, PTNS, and SNS in the management of OAB. BoNT/A is now recommended as standard third-line treatment for OAB (in the USA) and urgency incontinence (in the USA and in Europe) in selected patients refractory to pharmacological therapy. All available third-line treatment options for OAB/urgency urinary incontinence should be offered before surgery is contemplated. VIDEO ABSTRACT http://links.lww.com/COU/A7.
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Manríquez V, Guzmán R, Naser M, Aguilera A, Narvaez S, Castro A, Swift S, Digesu GA. Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial. Eur J Obstet Gynecol Reprod Biol 2015; 196:6-10. [PMID: 26645117 DOI: 10.1016/j.ejogrb.2015.09.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/02/2015] [Accepted: 09/17/2015] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Valentín Manríquez
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Chile.
| | - Rodrigo Guzmán
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Chile
| | - Michel Naser
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Chile
| | - Amalia Aguilera
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Chile
| | - Simonie Narvaez
- Pelvic Floor Unit, Obstetrics and Gynecology Department, Clinical Hospital, Universidad de Chile, Chile
| | - Ariel Castro
- Clinical Investigation Support Department, Clinical Hospital, Universidad de Chile, Chile
| | - Steven Swift
- Division of Urogynecology & Incontinence, Medical University of South Carolina, United States
| | - G Alessandro Digesu
- Imperial College Healthcare NHS Trust, Academic Department of Obstetrics & Gynaecology, United Kingdom
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Globerman D, Robert M. Heterogeneity in post-intervention prolapse and urinary outcome reporting: a one-year review of the International Urogynecology Journal. Int Urogynecol J 2015; 26:1373-8. [PMID: 25944659 DOI: 10.1007/s00192-015-2720-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This review aimed to examine post-intervention prolapse, incontinence, and overactive bladder outcome measures published in the International Urogynecology Journal over the previous year and to report on the heterogeneity in outcome reporting. METHODS All original article abstracts published in the print version of the International Urogynecology Journal in 2014 were reviewed for possible inclusion. Those reporting on prolapse and/or incontinence and/or overactive bladder outcomes following a urogynecological intervention were analyzed. Articles were reviewed for all reported outcomes. Outcomes were categorized as primary or secondary and objective or subjective. RESULTS Of 117 original articles published, 45 were reviewed. Among primary outcomes, 9 different outcomes were reported for prolapse and 11 for incontinence and overactive bladder. For prolapse, 6 different objective and 13 subjective outcomes were reported. For incontinence, 21 objective and 36 subjective outcomes were reported. Three different definitions were used for the outcome of "prolapse cure," 3 for "prolapse recurrence," and 4 for "stress incontinence cure." Several validated and non-validated questionnaires in addition to single unvalidated questions were used to measure subjective outcomes. CONCLUSIONS This research highlights the diversity in outcome reporting for prolapse, incontinence, and overactive bladder after an intervention in the last year of publications alone. This can lead to serious challenges in the generation of higher order evidence, such as systematic reviews and meta-analyses. As a subspecialty, we need to aim for more cohesive reporting so as to allow for robust comparison and evidence dissemination.
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Affiliation(s)
- Dobrochna Globerman
- Division of Urogynecology, Department of Obstetrics and Gynecology, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada,
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Abstract
Overactive bladder (OAB) is one of the most common bothersome urological diseases. It also has a negative economic impact. Pathophysiology entails changes in neurogenic and myogenic factors, as well as urinary biomarkers such as nerve growth factor (NGF) and prostaglandins (PGs). With symptoms from OAB-Dry to OAB-Wet, the urodynamic pattern of OAB bladder is often characterized by idiopathic detrusor overactivity with lower threshold of sensation, diminished compliance and capacity. Treatment ranges from a combination of behavioral modifications (BM)/ pelvic floor muscle training (PFMT) to combinations of antimuscarinics, Botox injection, nerve stimulation and augmentation cystoplasty. Herein, a contemporary review on the different aspects of management of refractory OAB in patients without neuropathic disorders is presented.
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de Groat WC, Tai C. Impact of Bioelectronic Medicine on the Neural Regulation of Pelvic Visceral Function. Bioelectron Med 2015. [DOI: 10.15424/bioelectronmed.2015.00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Quirouet A, Goldman HB. Management of Overactive Bladder Refractory to Medical Therapy. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0259-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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