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Liao L, Li X, Chong T, Chen Q, Xu Z, Huang B, Chen M, Li H, Wei Z, Shao Y, Lu J, Pang R, Li X, Wang Y. Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder. BJU Int 2024; 133:760-769. [PMID: 38468422 DOI: 10.1111/bju.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a wearable, smartphone-controlled, rechargeable transcutaneous tibial nerve stimulation (TTNS) device in patients with overactive bladder (OAB). PATIENTS AND METHODS This multicentre, prospective, single-blind, randomised clinical trial included eligible patients with OAB symptoms who were randomly assigned to the stimulation group or sham group. The primary efficacy outcome was change from baseline in voiding frequency/24 h after 4 weeks of treatment. The secondary efficacy outcomes included changes in bladder diary outcomes (urgency score/void, nocturia episodes/day, micturition volume/void, and incontinence episodes/day), questionnaires on Overactive Bladder Symptom Score (OABSS), Patient Perception of Bladder Condition (PPBC), and American Urological Association Symptom Index Quality of Life Score (AUA-SI-QoL) at baseline and after 4 weeks of treatment. Device-related adverse events (AEs) were also evaluated. RESULTS In the full analysis set (FAS), the mean (sd) change of voiding frequency/24 h in the stimulation group and sham group at 4 weeks were -3.5 (2.9) and -0.6 (2.4), respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -3.5 (2.9) vs -0.4 (2.3) (P < 0.01). In the FAS and PPS, micturition volume/void significantly improved at 4 weeks (P = 0.01 and P = 0.02). PPBC improvement almost reached significance in the FAS (P = 0.05), while it was significant in the PPS (P = 0.02). In the FAS and PPS, AUA-SI-QoL significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas there were no significant differences in urgency score/void, nocturia episodes/day or OABSS between the groups. Also, no device-related serious AEs were reported. CONCLUSIONS The non-invasive neuromodulation technique using the novel ambulatory TTNS device is effective and safe for treating OAB. Its convenience and easy maintenance make it a new potential home-based treatment modality. Future studies are warranted to confirm its longer-term efficacy.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Centre, China Rehabilitation Science Institute, Rehabilitation School of Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Centre, China Rehabilitation Science Institute, Rehabilitation School of Capital Medical University, Beijing, China
| | - Tie Chong
- Department of Urology, Second Affifiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Chen
- Department of Urology, Second Affifiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhihui Xu
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Banggao Huang
- Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Min Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoran Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhongqing Wei
- Department of Urology, Second Affifiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yunpeng Shao
- Department of Urology, Second Affifiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianxin Lu
- Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ran Pang
- Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xunhua Li
- Department of Urology, China Rehabilitation Research Centre, China Rehabilitation Science Institute, Rehabilitation School of Capital Medical University, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Yiming Wang
- Department of Urology, China Rehabilitation Research Centre, China Rehabilitation Science Institute, Rehabilitation School of Capital Medical University, Beijing, China
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Muacevic A, Adler JR, Kamasako T, Kaga M, Fuse M, Ishizuka M. Efficacy of Transcutaneous Tibial Nerve Stimulation With Silver Spike Point® Electrodes for Refractory Overactive Bladder: A Single-Arm Study. Cureus 2023; 15:e34166. [PMID: 36843763 PMCID: PMC9949902 DOI: 10.7759/cureus.34166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Background Tibial nerve stimulation therapy is a treatment option for an overactive bladder. A surface electrode called a Silver Spike Point® electrode, which does not directly puncture the skin as in transcutaneous tibial nerve stimulation, but is expected to exert the same therapeutic effect as percutaneous tibial nerve stimulation, was developed. This study investigated the efficacy and safety of tibial nerve stimulation with Silver Spike Point® electrodes for refractory overactive bladder. Methodology This was a six-week, single-arm, prospective study on the efficacy and safety of transcutaneous tibial nerve stimulation for patients with refractory overactive bladder. Each treatment lasted 30 minutes and was performed twice a week. The stimulation sites of the tibial nerve were the Sanyinjiao point (SP6) and Zhaohai point (KI6) in both legs. The primary endpoint was the change in the total overactive bladder symptom score. Results In total, 29 patients (20 males and nine females: 64.86 ± 17.98 years old) were included in this study. Two women dropped out; one because of an adverse event and the other as requested. Therefore, 27 patients completed the study. The total overactive bladder symptom and International Consultation on Incontinence Questionnaire-Short Form scores significantly decreased by 2.22 and 2.39 points, respectively (p < 0.01 each). In the frequency volume chart, the numbers of urgency episodes and leaks in 24 hours significantly decreased by 1.53 and 0.44, respectively (p = 0.02 each). Conclusions Transcutaneous tibial nerve stimulation therapy using Silver Spike Point® electrodes was useful for patients with refractory overactive bladder and, thus, has potential as a new treatment option for refractory overactive bladder.
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Bai J, Tian Y, Wang Y, Zhang X, Wang P. Physical and Rehabilitation Therapy for Overactive Bladder in Women: A Systematic Review and Meta-Analysis. Int J Clin Pract 2023; 2023:6758454. [PMID: 36704247 PMCID: PMC9833926 DOI: 10.1155/2023/6758454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To compare the effects of different physical and rehabilitation therapies on women with overactive bladder (OAB). DESIGN Network meta-analysis. Data source: The Embase, Scopus, and PubMed databases were systematically searched from their inception to June 22, 2022. We included only RCTs, with no language restrictions. Articles in the reference lists and related studies were thoroughly reviewed. Review Methods. This network meta-analysis included related studies on different physical and rehabilitation therapies for OAB. Data were extracted independently from the included randomized controlled trials by two authors, and they used the Cochrane Collaboration's tool to evaluate the risk of bias. We used RevMan to assess the risk assessment of research bias. This network meta-analysis was performed using the Stata software. We completed the review in accordance with the PRISMA items for systematic reviews and meta-analyses statement. RESULTS Twelve randomized controlled trials involving 637 patients were included in this meta-analysis. All physical and rehabilitation therapies improved daytime micturition frequency and nocturia frequency in OAB patients. Percutaneous tibial nerve stimulation (PTNS), BT + ES, and BT + BF + ES are better interventions for OAB treatment. There were no significant differences in PTNS, BT + ES, and BT + BF + ES. CONCLUSION All physical and rehabilitation therapies can improve daytime micturition and nocturia frequency in OAB. PTNS, BT + ES, and BT + BF + ES were the priority therapies.
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Affiliation(s)
- Jingwen Bai
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
- Department of Obstetrics and Gynecology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Yilan Tian
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Yiran Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Xiaofang Zhang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
| | - Ping Wang
- Department of Obstetrics and Gynecology, The West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu 610041, Sichuan Province, China
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Xu JJ, Zimmerman LL, Soriano VH, Mentzelopoulos G, Kennedy E, Bottorff EC, Stephan C, Kozloff K, Devlin MJ, Bruns TM. Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rat menopause model. Int Urogynecol J 2022; 33:3543-3553. [PMID: 35254469 DOI: 10.1007/s00192-022-05125-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Human menopause transition and post-menopausal syndrome, driven by reduced ovarian activity and estrogen levels, are associated with an increased risk for symptoms including but not limited to sexual dysfunction, metabolic disease, and osteoporosis. Current treatments are limited in efficacy and may have adverse consequences, so investigation for additional treatment options is necessary. Previous studies have demonstrated that percutaneous tibial nerve stimulation (PTNS) and electro-acupuncture near the tibial nerve are minimally invasive treatments that increase vaginal blood perfusion or serum estrogen in the rat model. We hypothesized that PTNS would protect against harmful reproductive and systemic changes associated with menopause. METHODS We examined the effects of twice-weekly PTNS (0.2 ms pulse width, 20 Hz, 2× motor threshold) under ketamine-xylazine anesthesia in ovariectomized (OVX) female Sprague-Dawley rats on menopause-associated physiological parameters including serum estradiol, body weight, blood glucose, bone health, and vaginal blood perfusion. Rats were split into three groups (n = 10 per group): (1) intact control (no stimulation), (2) OVX control (no stimulation), and (3) OVX stimulation (treatment group). RESULTS PTNS did not affect serum estradiol levels, body weight, or blood glucose. PTNS transiently increased vaginal blood perfusion during stimulation for up to 5 weeks after OVX and increased areal bone mineral density and yield load of the right femur (side of stimulation) compared to the unstimulated OVX control. CONCLUSIONS PTNS may ameliorate some symptoms associated with menopause. Additional studies to elucidate the full potential of PTNS on menopause-associated symptoms under different experimental conditions are warranted.
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Affiliation(s)
- Jiajie Jessica Xu
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI, USA.
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA.
- Division of Animal Resources, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Lauren L Zimmerman
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa H Soriano
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA
- Neuroscience Department, University of Michigan, Ann Arbor, MI, USA
| | - Georgios Mentzelopoulos
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
- Electrical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Eric Kennedy
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth C Bottorff
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
| | - Chris Stephan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth Kozloff
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Maureen J Devlin
- Anthropology Department, University of Michigan, Ann Arbor, MI, USA
| | - Tim M Bruns
- Biointerfaces Institute, University of Michigan, MI, Ann Arbor, USA.
- Biomedical Engineering Department, University of Michigan, Ann Arbor, MI, USA.
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Physical Agent-Based Treatments for Overactive Bladder: A Review. J Clin Med 2022; 11:jcm11175150. [PMID: 36079076 PMCID: PMC9456779 DOI: 10.3390/jcm11175150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Abstract
Almost one-fifth of the people in the world experience a decrease in quality of life due to overactive bladder (OAB) syndrome. The main bothersome symptoms are urgency accompanied by urinary frequency and nocturia. This chronic, disabling condition is first managed by reducing fluid intake and pelvic floor muscle training, supplemented with antimuscarinic drugs, if necessary. However, refractory cases often still occur. In more severe cases, invasive surgical interventions can be considered; yet, the success rate is still inconsistent, and there is a high complication rate. This condition is frustrating for patients and challenging for the medical staff involved. Although its pathophysiology has not been fully elucidated, peripheral autonomic somatic and sensory afferent receptors are considered to be involved in this condition. Hence, currently, physical agent-based treatments such as neuromodulation have taken a significant place in the third-line therapy of OAB. The efficacy and safety profiles of electrical and magnetic stimulation continue to evolve. Physical-based agents provide an appealing option owing to their effectiveness and minimal side effects. In addition, more physical therapies using light and shock energy are currently being investigated. Thus, a comprehensive understanding of these modalities is an extremely important aspect to provide the most suitable modalities for patients.
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Alkis O, Ozlu A, Kartal IG, Sevim M, Baser A, Aras B. How effectively do we apply first-line treatment in overactive bladder? Int Urogynecol J 2022; 33:2299-2306. [PMID: 35779110 DOI: 10.1007/s00192-022-05279-2] [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: 03/17/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to reveal the effectiveness of the combination of behavioral therapy (BT), drug therapy, and pelvic floor muscle training (PFMT) in patients with the diagnosis of overactive bladder (OAB) who did not respond to drug therapy. METHODS Seventy female patients aged between 18 and 65 years diagnosed with wet-type OAB, who did not respond to drug therapy, were included in our study, which was planned as a prospective randomized controlled trial. The patients were randomly assigned to one of two groups. BT and a combination of anticholinergic + beta3-agonist was implemented in the control group for 12 weeks. BT and PFMT were applied with a combination of anticholinergic + beta3-agonist in the active therapy group for 12 weeks. Post-treatment changes in OAB, ICIQ-SF scores, and frequency and nocturia were compared. RESULTS The age and BMI averages of the groups were similar (p>0.01). After the treatment, no significant decrease was observed in OAB scores in the control group (p = 0.06), but a significant decrease was observed in the active therapy group (p<0.01). The mean ICIQ-SF scores and the number of nocturia were found to decrease in both groups after 12 weeks of treatment (p<0.01). There was no significant decrease in frequency in the control group (p = 0.054). It regressed significantly in the active therapy group (p<0.01). After the treatment, 3 of 30 the patients in control group (10%) and 11 of the 32 patients in the active therapy group (34.3%) said that their complaints had regressed and that they were pleased with their current situation. Although after the treatment, 4 patients in the control group were dry (13.3%), 10 patients in the active therapy group were dry (31.25%). CONCLUSIONS We demonstrated that drug therapy, BT, and PFMT, which are recommended in the first-line treatment of OAB reduce the need for invasive treatments when they are well explained to the patients and combined.
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Affiliation(s)
- Okan Alkis
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey.
| | - Aysun Ozlu
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kütahya Health Science University, Kutahya, Turkey
| | - Ibrahim Guven Kartal
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
| | - Mehmet Sevim
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
| | - Aykut Baser
- Faculty of Medicine, Department of Urology, Bandırma Ondokuzeylül University, Bandırma, Turkey
| | - Bekir Aras
- Faculty of Medicine, Department of Urology, Kütahya Health Science University, Kutahya, Turkey
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Al-Danakh A, Safi M, Alradhi M, Almoiliqy M, Chen Q, Al-Nusaif M, Yang X, Al-Dherasi A, Zhu X, Yang D. Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines. PARKINSON'S DISEASE 2022; 2022:2700227. [PMID: 35400016 PMCID: PMC8984064 DOI: 10.1155/2022/2700227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/28/2022] [Indexed: 12/02/2022]
Abstract
Purpose of the Review. Posterior tibial nerve stimulation (PTNS) techniques have dramatically grown after approval to manage overactive bladder (OAB). The present review will focus on the most current data on PTNS types (percutaneous, transcutaneous, and implant) and their mechanism of action, safety, efficacy, advantages, drawbacks, limitation, and clinical applications. Recent Findings. The present review described the recent studies that addressed the tibial nerve stimulation role in OAB management. BlueWind RENOVA system, Bioness StimRouter, and eCoin are examples of emerging technologies that have evolved from interval sessions (percutaneous PTNS and transcutaneous PTNS) to continuous stimulation (implants). These can be efficiently managed at home by patients with minimum burden on the health system and fewer visits, especially in the COVID-19 pandemic. Summary. Our review shows that the tibial nerve stimulation advancements in OAB treatment have been rapidly increasing over the recent years. It is minimally invasive and effective, similar to sacral nerve stimulation (SNM), but less aggressive. Implantable PTNS has been promised in terms of efficacy, safety, and high acceptance rate. However, evidence is still limited to short-term trials, and tolerability, method, and drawbacks remain challenges.
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Affiliation(s)
- Abdullah Al-Danakh
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Mohammed Safi
- Department of Oncology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Mohammed Alradhi
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Marwan Almoiliqy
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Qiwei Chen
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Murad Al-Nusaif
- Department of Neurology, First Affiliated Hospital, Dalian Medical University, Dalian 116021, China
| | - Xuehan Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Aisha Al-Dherasi
- Department of Biochemistry, Faculty of Science, Ibb University, Ibb, Yemen
| | - Xinqing Zhu
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
| | - Deyong Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian 116021, China
- Healinghands (Dalian) Clinic, Dalian, Liaoning, China
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