Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults

Impact of a Community-Based Pelvic Floor Kinesic Rehabilitation Program on the Quality of Life of Chilean Adult Women with Urinary Incontinence

The pelvic floor forms the primary bottom tissue of the pelvic cavity. It comprises muscles that play a fundamental role in bowel and bladder emptying. Alterations of pelvic floor muscles will result in dysfunctions such as urinary incontinence (UI). Given the high prevalence of UI and its impact on the quality of life (QoL) in patients with pelvic floor muscle dysfunctions, it is necessary to implement public, community, and generalized programs focused on treating these dysfunctions.

OBJECTIVE

To determine the effect of a community rehabilitation program on QoL, UI severity, and pelvic floor muscle strength in patients with UI.

PATIENTS AND METHOD

A descriptive prospective cohort study. Twenty subjects between 44 and 75 years old with a diagnosis of UI, participants of a community kinesic rehabilitation program on the pelvic floor in Maipú, Santiago, Chile, were evaluated. These volunteers were intervened for six months, and QoL was measured with the 36-Item Short-Form Health Survey (SF-36) and International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) scales, UI severity with the Sandvick test, and pelvic floor muscle strength with the Oxford scale. Patients were followed up three months post-intervention.

RESULTS

Significant improvements were observed in all scales after applying for the community kinesic rehabilitation program, and the changes were maintained at a 3-month follow-up.

CONCLUSIONS

Since the improvement in QoL, UI severity, and pelvic floor muscle strength after the intervention, it is relevant to consider the implementation of community programs aimed at education, screening, and early rehabilitation of these patients.

Overactive Bladder in Frail Older Adults

Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.

[Treatment for refractory non-neurogenic overactive bladder]

INTRODUCTION

The aim was to synthesize current knowledge on refractory overactive bladder treatments.

METHOD

A systematic literature review based on PubMed, Embase and Google Scholar was conducted in July 2020.

RESULTS

Today, refractory overactive bladder treatment includes tibial nerve stimulation, whether percutaneously or transcutaneously, sacral neuromodulation, and botulinum toxin A detrusor injections. These conservative treatments have marginalized surgical treatments, which mainly involve supratrigonal cystectomy with augmentation cystoplasty. Several potential new treatments are being evaluated but can only be currently offered as part of clinical research protocols.

CONCLUSION

"Conservative" treatments for refractory overactive bladder have been shown to be effective. Other treatments could enrich the treatment options.