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Kyaw HY, Krause HG, Goh JTW. Percutaneous tibial nerve stimulation for the overactive bladder: A single-arm trial. Aust N Z J Obstet Gynaecol 2024. [PMID: 38632883 DOI: 10.1111/ajo.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
AIMS We hypothesise that PTNS is a safe and effective treatment for OAB. Overactive bladder (OAB) is estimated to affect 11.8% of women worldwide, causing diminished quality of life. Lifestyle modifications, muscarinic receptor antagonist and beta-adrenoreceptor agonist remain the mainstay of treatment but are limited by their efficacy and adverse effects. Access to third-line therapies of intravesical botulinum toxin type A or sacral neuromodulation is limited by their invasive nature. Percutaneous tibial nerve stimulation (PTNS) has emerged as a non-invasive treatment option for OAB. METHODS This study was a single-arm trial of women requesting third-line treatment for OAB. The primary treatment outcome was patient-reported visual analogue score (VAS) improvement of at least 50%. Secondary outcome measures were Urinary Distress Inventory Short Form (UDI-6) score and two-day bladder diary. Patients also provided feedback on adverse effects encountered. RESULTS In the 84 women recruited, initial treatment protocol showed a success rate of 77.2% among those who completed treatment based on VAS, with a statistically significant improvement in mean UDI-6 score of 20.13 (P < 0.01, standard deviation: 12.52). Continued success following tapering protocol of 60.8% and a mean maintenance protocol of 14.2 months was achieved. No adverse effects were reported. CONCLUSION The results from this study are in concordance with previously published literature on the effectiveness and safety of PTNS as a treatment modality for OAB. Further randomised controlled trials to evaluate the optimal treatment protocol are warranted to establish a standardised regime.
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Affiliation(s)
- Hnin Yee Kyaw
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Hannah G Krause
- Gold Coast University Hospital, Southport, Queensland, Australia
- University of Queensland, St Lucia, Queensland, Australia
- Ramsay Specialist Centre, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Judith T W Goh
- Gold Coast University Hospital, Southport, Queensland, Australia
- Ramsay Specialist Centre, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
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2
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Tahmasbi F, Salehi-Pourmehr H, Naseri A, Ghaderi S, Javadi-Farid F, Hajebrahimi S, Sedigh O, Soleimanzadeh F. Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review. Neurourol Urodyn 2024; 43:494-515. [PMID: 38153131 DOI: 10.1002/nau.25343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/26/2023] [Accepted: 11/16/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Lower urinary tract dysfunction (LUTD) is a common, troublesome condition that often negatively affects patients' quality of life. Current literature has long been interested in how posterior tibial nerve stimulation (PTNS) can affect this condition. AIM To extensively and systematically explore how PTNS affects LUTD based on the most recent systematic reviews. METHODS A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the systematic reviews, with or without meta-analysis that assessed the effects of PTNS on LUTD were retrieved. The quality of the included studies was assessed using the Joanna Briggs Institute tool, and analysis was conducted using the Comprehensive Meta-Analysis version 3 tool. RESULTS From a total of 3077 citations, 20 systematic reviews entered this study, and 13 of them included meta-analysis. The population of studies varied vastly, for instance, some studies included only children or women while other focused on a specific pathology like multiple sclerosis-induced neurogenic LUTD. The majority of included studies reported an overall improvement in LUTD following percutaneous PTNS, although admitting that these results were derived from moderate to low-quality evidence. CONCLUSION The findings of this thorough umbrella review showed that the positive benefits of PTNS in treating LUTD are currently supported by low-quality evidence, and it is crucial to interpret them with great care.
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Affiliation(s)
- Fateme Tahmasbi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Javadi-Farid
- Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Omid Sedigh
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Torino, Italy
| | - Farzin Soleimanzadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
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3
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O’Connor A, Reynolds E, Molyneux C, Vasant DH, Sharma A, Faulkner G, McLaughlin J, Kiff E, Telford K. Percutaneous tibial nerve stimulation versus sacral nerve stimulation for the treatment of faecal incontinence. Front Surg 2024; 11:1303119. [PMID: 38357189 PMCID: PMC10864541 DOI: 10.3389/fsurg.2024.1303119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Faecal incontinence (FI) is a common condition with a significant impact on quality of life (QoL). Neuromodulation treatments delivered by members of the multidisciplinary team including sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS) are options for FI refractory to conservative management. The aim of this study was to assess whether a successful treatment with one neuromodulation modality corresponds with success in the other. Methods A retrospective review of a prospectively managed neuromodulation database identified 15 patients who had undergone both PTNS and SNS. The definition of success of each treatment was a >50% improvement in any of The St. Mark's Incontinence Score, Manchester Health Questionnaire, or weekly faecal urgency or FI episodes. Results Complete data from 12 patients was available for assessment and PTNS was delivered as the first treatment in nine patients. Overall, seven patients (58%) had successful PTNS treatment, with 10 (83%) having a successful SNS trials. Of the seven patients who had successful PTNS treatment, six patients (85.4%) went on to have success with SNS. Of the five patients who failed PTNS, four (80%) went on to have SNS success. Five (71%) of those who had positive PTNS outcomes had permanent SNS implantation as their final treatment decision. Conclusion This study suggests that there is no clear relationship between successful PTNS treatment and an SNS trial period which may be explained by differing mechanisms of action or the potential placebo effect of PTNS. Further work is required to investigate any association in larger studies to inform clinical practice.
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Affiliation(s)
- Alexander O’Connor
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Elizabeth Reynolds
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Clare Molyneux
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Dipesh H. Vasant
- Neurogastroenterology Unit, Gastroenterology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester, Manchester, United Kingdom
| | - Abhiram Sharma
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
| | - Gemma Faulkner
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Edward Kiff
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Karen Telford
- Department of Colorectal Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
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Frey JN, Vidal A, Krebs J, Christmann C. Percutaneous Tibial Nerve Stimulation in the Treatment of Refractory Idiopathic Overactive Bladder Syndrome: A Retrospective Cohort Study. J Clin Med 2023; 12:6783. [PMID: 37959248 PMCID: PMC10648249 DOI: 10.3390/jcm12216783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) is a syndrome defined as urinary urgency, accompanied by increased frequency and nocturia with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology. The standard therapies are anticholinergic agents, selective beta-3 adrenoreceptor agonists, or intradetrusor injections of botulinum toxin (BTX-A). For patients with contraindications for BTX-A or drug therapies, percutaneous tibial nerve stimulation (PTNS) may be used. PTNS shows fewer side effects than anticholinergic drugs and costs less than BTX-A. The primary outcome of this study was to assess the efficacy of PTNS in women with refractory OAB. METHODS Women with refractory OAB undergoing PTNS at our tertiary referral center from 2017 to 2019 were included. The validated German Female Pelvic Floor Questionnaire and a micturition protocol were filled out before and after PTNS. PTNS was applied weekly for 12 weeks. RESULTS Improvements in OAB symptoms were seen in daily micturition frequency, urgency, and urgency incontinence from pre- to post-PTNS (p < 0.006). Impairments to quality of daily life were significantly (p < 0.0002) less severe after PTNS. There was a significant reduction in daytime voiding frequency from a median of nine to five (p < 0.0001). CONCLUSIONS Substantial reductions in OAB symptoms, daily micturition frequency, urgency, and urgency incontinence were found in patients with refractory OAB after PTNS.
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Affiliation(s)
- Janine Nicole Frey
- Luzerner Kantonsspital Frauenklinik, Spitalstrasse, 6000 Luzern, Switzerland; (A.V.); (C.C.)
| | - Angela Vidal
- Luzerner Kantonsspital Frauenklinik, Spitalstrasse, 6000 Luzern, Switzerland; (A.V.); (C.C.)
| | - Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, 6207 Nottwil, Switzerland;
| | - Corina Christmann
- Luzerner Kantonsspital Frauenklinik, Spitalstrasse, 6000 Luzern, Switzerland; (A.V.); (C.C.)
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Sevim M, Alkiş O, Kartal İG, Kazan HO, İvelik Hİ, Aras B, Kabay Ş. Comparison of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain syndrome: A randomized prospective trial. Prostate 2023; 83:751-758. [PMID: 36871235 DOI: 10.1002/pros.24513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a heterogenous condition that impacts the Quality of life severely, and it has multimodal complex treatment options. We aimed to compare the efficacy of two well-described neuromodulation therapies, transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in the treatment of category IIIB CP/CPPS. METHODS This study was designed as a randomized prospective clinical trial. We randomized category IIIB CP/CPPS patients into two treatment groups as TTNS and PTNS groups. Category IIIB CP/CPPS was diagnosed by two or four-glass Meares-Stamey test. All patients included in our study were antibiotic/anti-inflammatory resistant. Transcutaneous and percutaneous treatments were applied 30 min sessions for 12 weeks. Patients were evaluated by Turkish-validated National Health Institute Chronic Prostatitis Symptom Index (NIH-CPSI) and visual analogue scale (VAS) initially and after treatment. Treatment success was evaluated within each group and also compared with each other. RESULTS A total of 38 patients in the TTNS group and 42 patients in the PTNS group were included in the final analysis. The mean VAS scores of the TTNS group were lower than the PTNS group initially (7.11 and 7.43, respectively), (p = 0.03). The pretreatment NIH-CPSI scores were similar between groups (p = 0.07). VAS scores, total NIH-CPSI, NIH-CPSI micturation, NIH-CPSI pain, and NIH-CPSI QoL scores decreased significantly at the end of the treatment in both groups. We found a significantly higher VAS and NIH-CPSI scores decrease in the PTNS group compared to the TTNS group (p < 0.01). CONCLUSION Both PTNS and TTNS are effective treatment methods in category IIIB CP/CPPS. Comparing the two methods, PTNS provided a higher level of improvement in terms of pain and quality of life.
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Affiliation(s)
- Mehmet Sevim
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Okan Alkiş
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - İbrahim Güven Kartal
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Huseyin Ozgur Kazan
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Halil İbrahim İvelik
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Bekir Aras
- Department of Urology, Faculty of Medicine, Kutahya Health Sciences University, Kütahya, Turkey
| | - Şahin Kabay
- Department of Urology, Faculty of Medicine, Altinbas University, Istanbul, Turkey
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Carilli M, Pacini P, Serati M, Iacovelli V, Bianchi D, Petta F, Pastore S, Amato I, Fede Spicchiale C, D’Ippolito G, Pletto S, Cavaleri Y, D’Amico A, Parisi I, Finazzi Agrò E. Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: a historically controlled study. Ther Adv Urol 2023; 15:17562872231177779. [PMID: 37275300 PMCID: PMC10233582 DOI: 10.1177/17562872231177779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Background Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking.Objective:: To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies. Methods MS patients with NDO were enrolled. Inclusion criteria were NDO not responding to pharmacological and behavioural therapies. Exclusion criteria were the presence of relevant comorbidities and urinary tract infections. Patients were evaluated using 3-day bladder diaries and validated questionnaires at baseline, after 4 weeks of educational therapy and after 12 PTNS sessions. The primary outcome measure was the percentage of patients considered responders after the behavioural therapy and after the PTNS in a historical controlled fashion (definition of 'responder' was reduction ⩾50% of urgency episodes). Results A total of 33 patients (26 women, 7 men) were enrolled. Two patients dropped out for reasons not related to the protocol. Two out of 31 patients (6.5%) and 21/29 (72.4%) were considered responders at visits 1 and 2, respectively. In PTNS responders, a statistically significant improvement in both bladder diary results and standardized questionnaire scores was recorded, compared with that obtained with behavioural therapy alone. No serious adverse events were reported. Conclusion This historically controlled study suggests that PTNS may be effective in improving NDO in MS patients.
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Affiliation(s)
| | | | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del
Ponte Hospital, University of Insubria, Varese, Italy
| | - Valerio Iacovelli
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
- Urology Unit, San Carlo di Nancy Hospital, GVM
Care and Research, Rome, Italy
| | - Daniele Bianchi
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
| | - Filomena Petta
- Urology Unit, San Carlo di Nancy Hospital, GVM
Care and Research, Rome, Italy
| | - Serena Pastore
- Division of Urology, Department of Surgery, Tor
Vergata University Hospital, Rome, Italy
| | - Ivana Amato
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | | | - Giulia D’Ippolito
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | - Simone Pletto
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | - Yuri Cavaleri
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
| | | | | | - Enrico Finazzi Agrò
- Division of Urology, Department of Surgery,
Tor Vergata University Hospital, Rome, Italy
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Wu S, Sun X, Liu X, Li J, Yang X, Bao Y, Yu H. Clinical Observations of Percutaneous Tibial Nerve Stimulation Combined with Sacral Nerve Root Magnetic Stimulation for the Treatment of Male Chronic Pelvic Pain and Chronic Prostatitis. ARCH ESP UROL 2022; 75:813-8. [PMID: 36651091 DOI: 10.56434/j.arch.esp.urol.20227510.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate the clinical efficacy of percutaneous tibial nerve stimulation combines sacral nerve root magnetic stimulation in the treatment of chronic pelvic pain syndrome and chronic prostatitis. METHODS 60 male patients diagnosed with chronic pelvic pain syndrome or chronic prostatitis were analyzed in this study. Patients in the experimental group were treated with percutaneous tibial nerve stimulation (7 Hz) combined with sacral nerve root magnetic stimulation (5 Hz) whilst patients in the control group receiving treatment with only percutaneous tibial nerve stimulation. The National Institutes of Health-Chronic Prostatitis Symptom Index was used to evaluate prostatitis in the 2 groups before and at 4 weeks after treatment. RESULTS All patients showed improvements in scores before and after treatment in the two groups (p < 0.05). Further comparison between the two groups showed that patients in the experimental experienced more significant improvements in each of the indicators compare that to the control group patients (p < 0.05). CONCLUSIONS Both percutaneous tibial nerve stimulation and percutaneous tibial nerve stimulation combined with magnetic stimulation of the sacral nerve roots have benefits for patients, but the benefits are more excellent when used together than when used alone.
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8
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Kim S, Na HS, Park JM, Kim JW. Novel botulinum neurotoxin-A tibial nerve perineural injection to alleviate overactive bladder symptoms in male rats. Anim Cells Syst (Seoul) 2022; 26:283-290. [PMID: 36605585 PMCID: PMC9809416 DOI: 10.1080/19768354.2022.2136239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Although tibial nerve modulation has shown to induce positive changes in the overactive bladder (OAB), prolonged therapeutic effects using percutaneous stimulation have not yet been achieved. Intradetrusor onabotulinum toxin A injection can provide prolonged therapeutic effects; however, its delivery requires invasive measures. By applying local relief of tibial nerve neural entrapment with onabotulinum toxin A injection, this study investigated the feasibility and efficacy of combining the abovementioned two therapeutic strategies. An OAB animal model was developed using 12 adult Sprague-Dawley rats with cyclophosphamide intraperitoneal injection. A perineural injection site comparable to the tibial nerve perineural injection site and corresponding to that in humans was identified and developed in rats. The toxin was injected five days after establishing the OAB. The incision was made in the skin on the lateral surface of the thigh. The biceps femoris muscle was cut across, exposing the sciatic nerve and its three terminal branches: the sural, common peroneal, and tibial nerves, and 100 units of onabotulinum toxin A was injected into the surrounding tissue. Five days following injection, cystometry was performed. Inter-contraction time, contraction pressure, and interval of the disease state improved with statistical significance. The OAB animal model showed significant improvement with the tibial nerve perineural injection of botulinum toxin, thereby suggesting the possibility of a comparable treatment adaptation in humans.
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Affiliation(s)
- Seungbeom Kim
- Department of Biomedical Science, Kyung Hee University, Seoul, Korea
| | - Hyun Seok Na
- Department of Urology, Chungnam National University Hospital, Daejon, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Hospital, Daejon, Korea,Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jin Wook Kim
- Department of Medical Informatics, Chung-Ang University, Seoul, Korea,Department of Urology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea, Jin Wook Kim Department of Urology, Chung-Ang University Gwangmyeong Hospital, Deokan Ro 110, Gwangmyeong, GyeonggiKR 14353, Korea
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9
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Alomari MS, Abdulhamid AS, Ghaddaf AA, Alshareef KM, Haneef AK, AlQuhaibi MS, Banjar RA. Non-inferior and more feasible transcutaneous tibial nerve stimulation in treating overactive bladder: A systematic review and meta-analysis. Int J Urol 2022; 29:1170-1180. [PMID: 35711082 DOI: 10.1111/iju.14961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Overactive bladder (OAB) is identified as a urinary urgency accompanied by frequency and nocturia with or without urgency urinary incontinence in the nonexistence of a urinary tract infection or other evident pathologies. This systematic review and meta-analysis aimed to evaluate the efficacy of the transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) or anticholinergic drugs in reducing symptoms and improving the quality of life for OAB patients. METHODS We performed a systematic search in Medline, Embase, and CENTRAL, in which we included randomized controlled trials that compared TTNS with anticholinergic drugs or PTNS in treating idiopathic OAB. We evaluated the following outcomes: 3-day voiding diary (voiding frequency/day, daytime micturition frequency/day, nighttime micturition frequency/day, number of urgency episodes/day, number of incontinence episodes/day, and mean voiding volume), symptom bother, health related quality of life (HRQoL), and adverse events. We used 95% as a confidence interval (CI) and p < 0.05. Standardized mean difference (SMD) was used for continuous outcomes, and the risk ratio (RR) was used for dichotomous outcomes. RESULTS There was no significant difference comparing TTNS with anticholinergic drugs or PTNS regarding voiding frequency/day (SMD = -0.01, 95% CI -0.33 to 0.32), nighttime micturition frequency/day (SMD = -0.28, 95% CI -0.94 to 0.37), number of urgency episodes/day (SMD = -0.05, 95% CI -0.36 to 0.26), number of incontinence episodes/day (SMD = -0.04, 95% CI -0.32 to 0.25), symptom bother (SMD = -0.19, 95% CI -0.55 to 0.16), HRQoL (SMD = 0.27, 95% CI -0.32 to 0.85), and adverse events (RR = 0.07, 95% CI 0.01 to 0.54). CONCLUSION The current meta-analysis reveals that there is no statistically significant difference between TTNS versus PTNS or anticholinergic drugs for the nonsurgical management of OAB patients.
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Affiliation(s)
- Mohammed S Alomari
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S Abdulhamid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah A Ghaddaf
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Khalid M Alshareef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed K Haneef
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Mohammad S AlQuhaibi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Rowaa A Banjar
- Department of Urology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
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10
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Kapriniotis K, Jenks J, Toia B, Pakzad M, Gresty H, Stephens R, Malde S, Sahai A, Greenwell T, Ockrim J. Does response to percutaneous tibial nerve stimulation predict similar outcome to sacral nerve stimulation? Neurourol Urodyn 2022; 41:1172-1176. [PMID: 35481714 DOI: 10.1002/nau.24944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 11/07/2022]
Abstract
AIMS Percutaneous tibial nerve stimulation (PTNS) is a simple neuromodulation technique to treat an overactive bladder. It is unclear whether the response to PTNS would suggest a similar response to sacral nerve stimulation (SNS), and whether PTNS could be utilized as an alternative test phase for an SNS implant. This study assessed whether PTNS response was a reliable indicator for subsequent SNS trials. METHODS We performed a retrospective review of the hospital databases to collect all patients who had PTNS and who subsequently had an SNS trial in two tertiary hospitals from 2014 to 2020. Response to both interventions was assessed. A 50% reduction in overactive symptoms (frequency-volume charts) was considered a positive response. McNemar's tests using exact binomial probability calculations were used. The statistical significance level was set to 0.05. RESULTS Twenty-three patients who had PTNS subsequently went on to a trial of SNS. All patients except one had previously poor response to PTNS treatment. Eight of them also failed the SNS trial. However, 15 patients (including the PTNS responder) had a successful SNS trial and proceeded with the second-stage battery implantation. The difference in response rates between the PTNS and SNS trial was statistically significant (p < 0.001). CONCLUSIONS Poor response to PTNS does not seem to predict the likelihood of patients responding to SNS. A negative PTNS trial should not preclude a trial of a sacral nerve implant. The predictive factors for good and poor responses will be the subject of a larger study.
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Affiliation(s)
| | - Julie Jenks
- Department of Urology, University College London Hospital, London, UK
| | - Bogdan Toia
- Department of Urology, University College London Hospital, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | - Helena Gresty
- Department of Urology, University College London Hospital, London, UK
| | - Ross Stephens
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy Ockrim
- Department of Urology, University College London Hospital, London, UK
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Zyczynski HM, Richter HE, Sung VW, Lukacz ES, Arya LA, Rahn DD, Visco AG, Mazloomdoost D, Carper B, Gantz MG. Percutaneous Tibial Nerve Stimulation vs Sham Stimulation for Fecal Incontinence in Women: NeurOmodulaTion for Accidental Bowel Leakage Randomized Clinical Trial. Am J Gastroenterol 2022; 117:654-667. [PMID: 35354778 PMCID: PMC8988447 DOI: 10.14309/ajg.0000000000001605] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/19/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To determine whether percutaneous tibial nerve stimulation (PTNS) is superior to sham stimulation for the treatment of fecal incontinence (FI) in women refractory to first-line treatments. METHODS Women aged 18 years or older with ≥3 months of moderate-to-severe FI that persisted after a 4-week run-in phase were randomized 2:1 (PTNS:sham stimulation) to 12 weekly 30-minute sessions in this multicenter, single-masked, controlled superiority trial. The primary outcome was change from baseline FI severity measured by St. Mark score after 12 weeks of treatment (range 0-24; minimal important difference, 3-5 points). The secondary outcomes included electronic bowel diary events and quality of life. The groups were compared using an adjusted general linear mixed model. RESULTS Of 199 women who entered the run-in period, 166 (of 170 eligible) were randomized, (111 in PTNS group and 55 in sham group); the mean (SD) age was 63.6 (11.6) years; baseline St. Mark score was 17.4 (2.7); and recording was 6.6 (5.5) FI episodes per week. There was no difference in improvement from baseline in St. Mark scores in the PTNS group when compared with the sham group (-5.3 vs -3.9 points, adjusted difference [95% confidence interval] -1.3 [-2.8 to 0.2]). The groups did not differ in reduction in weekly FI episodes (-2.1 vs -1.9 episodes, adjusted difference [95% confidence interval] -0.26 [-1.85 to 1.33]). Condition-specific quality of life measures did not indicate a benefit of PTNS over sham stimulation. Serious adverse events occurred in 4% of each group. DISCUSSION Although symptom reduction after 12 weeks of PTNS met a threshold of clinical importance, it did not differ from sham stimulation. These data do not support the use of PTNS as conducted for the treatment of FI in women.
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Affiliation(s)
- Halina M. Zyczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh/ Magee-Womens Research Institute, Pittsburgh, PA
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Vivian W. Sung
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women’s & Infants Hospital, Providence, RI
| | - Emily S. Lukacz
- Department of Obstetrics, Gynecology & Reproductive Sciences, UC San Diego Health, San Diego, CA
| | - Lily A. Arya
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, PA
| | - David D. Rahn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Anthony G. Visco
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States
| | - Benjamin Carper
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, United States
| | - Marie G. Gantz
- Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, United States
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Yang DY, Zhao LN, Qiu MX. Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation. Medicine (Baltimore) 2021; 100:e25941. [PMID: 34011072 PMCID: PMC8137095 DOI: 10.1097/md.0000000000025941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder. METHODS A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses. RESULTS A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = -0.65, 95% confidence interval [CI]: -1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: -0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: -0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = -0.14, 95% CI: -0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores (P = .23) and incontinence quality of life scores (P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group. CONCLUSION Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.
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Affiliation(s)
| | - Liu-Ni Zhao
- Department of Urology, People's Hospital of Sichuan Province, Chengdu, People's Republic of China
| | - Ming-Xing Qiu
- Department of Urology, People's Hospital of Sichuan Province, Chengdu, People's Republic of China
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13
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Ho FCS, He C, Yao HHI, O'Connell HE, Gani J. Efficacy of sacral neuromodulation and percutaneous tibial nerve stimulation in the treatment of chronic nonobstructive urinary retention: A systematic review. Neurourol Urodyn 2021; 40:1078-1088. [PMID: 33973670 DOI: 10.1002/nau.24694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
AIM The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads. METHODS This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long-term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool. RESULTS A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%-100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%-60% range and complications were minimal. CONCLUSION SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR.
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Affiliation(s)
- Felicia Ching Siew Ho
- Department of Urology, Western Health, University of Melbourne, Melbourne, Australia
| | - Carl He
- Department of Urology, Western Health, University of Melbourne, Melbourne, Australia
| | - Henry Han-I Yao
- Department of Urology, Western Health, University of Melbourne, Melbourne, Australia
| | - Helen E O'Connell
- Department of Urology, Western Health, University of Melbourne, Melbourne, Australia
| | - Johan Gani
- Department of Urology, Western Health, University of Melbourne, Melbourne, Australia.,Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia
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14
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Sönmez R, Yıldız N, Alkan H. Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial. Ann Phys Rehabil Med 2021; 65:101486. [PMID: 33429090 DOI: 10.1016/j.rehab.2021.101486] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Different studies have reported the efficacy of percutaneous tibial nerve stimulation (PTNS) and transcutaneous tibial nerve stimulation (TTNS) in treating idiopathic overactive bladder (OAB). However, no study has compared the effectiveness of PTNS and TTNS added to bladder training (BT) in idiopathic OAB. OBJECTIVE To compare the efficacy of PTNS and TTNS added to BT in women with idiopathic OAB. METHODS We randomised 60 women with idiopathic OAB into 3 groups. Group 1 (n=19) received BT, Group 2 (n=19) received PTNS in addition to BT, and Group 3 (n=20) received TTNS in addition to BT. PTNS and TTNS were performed 2 days a week, for 30 min a day, for a total of 12 sessions for 6 weeks. Patients were evaluated by incontinence severity (pad test), a 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia and number of pads used), symptom severity, quality of life, treatment success (positive response rate), treatment satisfaction (Likert scale), discomfort level and preparation time for stimulation (sec). RESULTS At the end of treatment; severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads used, symptom severity and quality of life were significantly improved in Groups 2 and 3 versus Group 1 (p<0.0167). Treatment success and treatment satisfaction were higher in Groups 2 and 3 than Group 1 (p<0.001 and p<0.0167, respectively). Level of discomfort was lower, treatment satisfaction was higher and preparation time for stimulation was shorter in Group 3 than Group 2 (p<0.05). CONCLUSION Both the PTNS plus BT and TTNS plus BT were more effective than BT alone in women with idiopathic OAB. These 2 tibial nerve stimulation methods had similar clinical efficacy but with slight differences: TTNS had shorter preparation time, less discomfort level and higher patient satisfaction than PTNS.
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Affiliation(s)
- Rafet Sönmez
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey
| | - Necmettin Yıldız
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey.
| | - Hakan Alkan
- Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Denizli, Turkey
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Du C, Berg WT, Siegal AR, Huang Z, Nguyen A, Cheung A, Mehraban-Far S, Anderson R, Jacob S, Kim J. A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies? Neurourol Urodyn 2020; 40:391-396. [PMID: 33197059 DOI: 10.1002/nau.24573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/17/2020] [Accepted: 10/29/2020] [Indexed: 11/11/2022]
Abstract
AIMS Third-line therapies are efficacious in improving overactive bladder (OAB) symptoms; however, OAB patients have poor follow-up and rarely progress to these therapies. Clinical care pathways (CCP) may improve OAB follow-up rates and third-line therapy use. We sought to determine how new OAB patients follow up and utilize third-line therapies with the implementation of an OAB CCP in a fellowship Female Pelvic Medicine and Reconstructive Surgery (FPMRS) trained urologist's academic practice. METHODS We identified new OAB patients using ICD-9 and 10 codes. They were placed into two groups: pre- and post-CCP use. Basic demographic data were collected. Patients were evaluated in a retrospective longitudinal fashion over 12 months to determine follow-up and third-line therapy utilization. RESULTS A total of 769 new OAB patients (261 pre-CCP and 508 post-CCP) were identified. The mean number of follow-up visits increased significantly at 6 months (0.94 vs. 1.64 visits, p = .001) and 12 months (1.26 vs. 2.46 visits, p < .003). Follow-up rates increased significantly at 3 months (38.7% vs. 50.2%, p = .002). Mean time to third-line therapy decreased significantly (280 days vs. 160 days, p = .016). Third-line therapy utilization therapy rates increased at 6 months (7.7% vs. 13.4%, p = .018) and at 12 months (11.1% vs. 16.5%, p = .044). CONCLUSIONS New OAB patients follow-up and progress to third-line therapies faster and more frequently with the use of a CCP in an FPMRS-trained urologist practice. However, many OAB patients still fail to follow up and overall utilization of third-line therapies remains low. Future studies are warranted to identify factors to why overall OAB compliance remains low.
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Affiliation(s)
- Chris Du
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - William T Berg
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Alexandra R Siegal
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Zhenyue Huang
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Anh Nguyen
- Division of Urology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Alice Cheung
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Sina Mehraban-Far
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Rebecca Anderson
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Sophia Jacob
- Renaissaince School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Jason Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
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16
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Kraus SR, Shiozawa A, Szabo SM, Qian C, Rogula B, Hairston J. Treatment patterns and costs among patients with OAB treated with combination oral therapy, sacral nerve stimulation, percutaneous tibial nerve stimulation, or onabotulinumtoxinA in the United States. Neurourol Urodyn 2020; 39:2206-2222. [PMID: 32827230 PMCID: PMC7693053 DOI: 10.1002/nau.24474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 12/04/2022]
Abstract
Introduction Treatment patterns and costs were characterized among patients with overactive bladder (OAB) receiving later‐line target therapies (combination mirabegron/antimuscarinic, sacral nerve stimulation [SNS], percutaneous tibial nerve stimulation [PTNS], or onabotulinumtoxinA). Methods In a retrospective cohort study using 2013 to 2017 MarketScan databases, two partially overlapping cohorts of adults with OAB (“IPT cohort”: patients with incident OAB pharmacotherapy use; “ITT cohort,” incident target therapy) with continuous enrollment were identified; first use was index. Demographic characteristics, treatment patterns and costs over the 24‐month follow‐up period were summarized. Crude mean (standard deviation [SD]) OAB‐specific (assessed by OAB diagnostic code or pharmaceutical dispensation record) costs were estimated according to target therapy. Results The IPT cohort comprised 54 066 individuals (mean [SD] age 58.5 [15.0] years; 76% female), the ITT cohort, 1662 individuals (mean [SD] age 62.8 [14.9] years; 83% female). Seventeen percent of the IPT cohort were treated with subsequent line(s) of therapy after index therapy; among those, 73% received antimuscarinics, 23% mirabegron, and 1.4% a target therapy. For the ITT cohort, 32% were initially treated with SNS, 27% with onabotulinumtoxinA, 26% with combination mirabegron/antimuscarinic, and 15% with PTNS. Subsequently, one‐third of this cohort received additional therapies. Mean (SD) costs were lowest among patients receiving index therapy PTNS ($6959 [$7533]) and highest for SNS ($29 702 [$26 802]). Conclusions Costs for SNS over 24 months are substantially higher than other treatments. A treatment patterns analysis indicates that oral therapies predominate; first‐line combination therapy is common in the ITT cohort and uptake of oral therapy after procedural options is substantial.
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Affiliation(s)
- Stephen R Kraus
- Department of Urology, University of Texas Health Sciences Center, San Antonio, Texas, San Antonio, Texas
| | - Aki Shiozawa
- Medical Affairs, Astellas Pharma Global Development Inc, Northbrook, Illinois
| | | | | | - Basia Rogula
- Health Economics, Broadstreet HEOR, Vancouver, Canada
| | - John Hairston
- Medical Affairs, Astellas Pharma Global Development Inc, Northbrook, Illinois
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Salatzki J, Liechti MD, Spanudakis E, Gonzales G, Baldwin J, Haslam C, Pakzad M, Panicker JN. Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder. BJU Int 2019; 123:E20-E28. [PMID: 30552801 DOI: 10.1111/bju.14651] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify factors influencing return for maintenance percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for overactive bladder (OAB). PATIENTS AND METHODS Patients with OAB symptoms referred for PTNS treatment underwent 12 sessions of weekly PTNS treatment and were evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB, the International Consultation on Incontinence Questionnaire on lower urinary tract symptom-related quality of life (ICIQ-LUTSqol) and a bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measures, were invited to return for maintenance treatment when symptoms returned. A PTNS Service Evaluation Questionnaire was used to evaluate factors influencing return for maintenance treatment. RESULTS Seventy-three patients were evaluated (mean age 58.9 [±14.7] years, 72.6% women) and clustered into three groups: group 1 (n = 25) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n = 17) responded to treatment but did not return for maintenance treatment and group 3 (n = 31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD variables among the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2: -1.54 ± 1.85; group 3: -1.85 ± 2.28; P < 0.05); however, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference = -0.4 ± 0.7 [P < 0.05] and ICIQ-LUTSqol difference -0.48 ± 0.94 [P < 0.05]), and perceived benefits of the treatment with regard to their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups 25.6%; P = 0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment based on a logistic regression analysis. Factors related to the need for repeat clinic visits, such as transportation, distance and time commitment, were not found to differ between the two groups. CONCLUSIONS Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The BD provides a more objective assessment of treatment outcome after PTNS treatment.
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Affiliation(s)
- Janek Salatzki
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.,Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina D Liechti
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Eleonora Spanudakis
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Gwen Gonzales
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Joanne Baldwin
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Mahreen Pakzad
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
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18
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Kozma B, Majoros A, Pytel Á, Póka R, Takács P. [Efficacy of the percutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms]. Orv Hetil 2018; 159:1735-1740. [PMID: 30346235 DOI: 10.1556/650.2018.31228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive, safe and well-tolerated neuromodulation technique for the lower urinary tract dysfunctions. PTNS delivers neuromodulation to the pelvic floor through the S2-4 junction of the sacral nerve plexus via the route of the posterior tibial nerve. Using the fine needle electrode insertion above the ankle, the tibial nerve is accessed, which connected to the stimulator. To date despite of its excessive clinical use, PTNS mechanism of action still remains unclear. The technique seems to be an efficacious and safe treatment for overactive bladder syndrome (OAB). It could be recommended according to the Urinary Incontinence Guideline of the European Association of Urology in women who did not have adequate improvement or could not tolerate anti-muscarinic therapy. The success rate is comparable to sacral nerve stimulation in OAB patients. PTNS has been used for fecal incontinence since 2003, however, many of the published studies are of poor quality. PTNS has also been shown to have positive effects on chronic pelvic pain, when the usual therapeutic steps did not result in satisfactory improvement. No major complications are reported in the literature, following PTNS treatment. Orv Hetil. 2018; 159(43): 1735-1740.
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Affiliation(s)
- Bence Kozma
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Attila Majoros
- Urológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ákos Pytel
- Urológiai Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | - Róbert Póka
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032
| | - Péter Takács
- Szülészeti és Nőgyógyászati Intézet, Debreceni Egyetem, Általános Orvostudományi Kar Debrecen, Nagyerdei krt. 98., 4032.,Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School Norfolk, VA, Amerikai Egyesült Államok
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19
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Hounsome N, Roukas C. Cost-effectiveness of sacral nerve stimulation and percutaneous tibial nerve stimulation for faecal incontinence. Therap Adv Gastroenterol 2018; 11:1756284818802562. [PMID: 30305847 PMCID: PMC6176537 DOI: 10.1177/1756284818802562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/23/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Subcutaneous sacral nerve stimulation is recommended by the United Kingdom (UK) National Institute for Health and Care Excellence (NICE) as a second-line treatment for patients with faecal incontinence who failed conservative therapy. Sacral nerve stimulation is an invasive procedure associated with complications and reoperations. This study aimed to investigate whether delivering less invasive and less costly percutaneous tibial nerve stimulation prior to sacral nerve stimulation is cost-effective. METHODS A decision analytic model was developed to estimate the cost-effectiveness of percutaneous tibial nerve stimulation with subsequent subcutaneous sacral nerve stimulation versus subcutaneous sacral nerve stimulation alone. The model was populated with effectiveness data from systematic reviews and cost data from randomized studies comparing both procedures in a UK National Health Service (NHS) setting. RESULTS Offering percutaneous tibial nerve stimulation prior to sacral nerve stimulation (compared with delivering sacral nerve stimulation straight away) was both more effective and less costly in all modeled scenarios. The estimated savings from offering percutaneous tibial nerve stimulation first were £662-£5,697 per patient. The probability of this strategy being cost-effective was around 80% at £20,000-£30,000 per quality-adjusted life-year (QALY). CONCLUSION Our analyses suggest that offering patients percutaneous tibial nerve stimulation prior to sacral nerve stimulation can be both cost-effective and cost-saving in the treatment of faecal incontinence.
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Affiliation(s)
| | - Chris Roukas
- Pragmatic Clinical Trials Unit, Queen Mary
University of London, London, UK
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20
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Hare N, Georgopoulos P, Philips KE, Johnson JE, Seary C, Panicker JN, Stevenson VL. Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking. Clin Rehabil 2018; 32:1357-1362. [PMID: 29909652 DOI: 10.1177/0269215518780974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Functional electrical stimulation is used to improve walking speed and reduces falls in people with upper motor neurone foot-drop. Following anecdotal observations of changes in bladder symptoms, an observational study was performed to explore this association further. DESIGN A total of 47 consecutive patients attending for setup with functional electrical stimulation during a six-month period were asked to complete a questionnaire assessing bladder symptoms (ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder)) at baseline and three months during routine appointments. SUBJECTS In all, 35 (75%) had multiple sclerosis and the other 12 subjects had a total of 9 diagnoses including 3 with stroke. Other conditions included cerebral palsy, motor neurone disease, hereditary spastic paraparesis, meningioma and spinocerebellar ataxias. RESULTS Improvement in overactive bladder symptoms was not significant in the whole cohort, however, was significant in patients with multiple sclerosis ( n = 35; mean change in ICIQ-OAB score 1.0, P = 0.043). Specifically, significant improvements were seen in urgency and urge incontinence in multiple sclerosis patients. There was a significant negative correlation of moderate strength within the multiple sclerosis cohort between baseline walking speed and subsequent change in ICIQ-OAB score (correlation coefficient of r = -0.40, P = 0.046). Thus, greater changes in bladder symptoms were seen with lower baseline walking speeds. CONCLUSION The results of this exploratory study suggest that functional electrical stimulation use does improve overactive bladder symptoms in people with multiple sclerosis. Further exploration is needed to study this association and explore whether the mechanism is similar to that of percutaneous tibial nerve stimulation, a recognized treatment for the overactive bladder.
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Affiliation(s)
- Nicola Hare
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Petros Georgopoulos
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kate E Philips
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Joanne E Johnson
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Coralie Seary
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jalesh N Panicker
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,2 Institute of Neurology, University College London, London, UK
| | - Valerie L Stevenson
- 1 The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,2 Institute of Neurology, University College London, London, UK
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21
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Kim JI, Choi TY, Jun JH, Kang H, Lee MS. Acupuncture for management of lower urinary tract symptoms in Parkinson's disease: A protocol for the systematic review of randomized controlled trials. Medicine (Baltimore) 2018; 97:e9821. [PMID: 29419682 PMCID: PMC5944678 DOI: 10.1097/md.0000000000009821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Acupuncture is claimed to improve the lower urinary tract symptoms (LUTS). Currently, no systematic reviews are performed for acupuncture on LUTS in patients with Parkinson's diseases (PD). This review aims to evaluate the current evidence on the efficacy of acupuncture for the management of LUTS in PD. METHODS AND ANALYSES Eleven databases will be searched from their inception. These include PubMed, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases, and 1 Chinese medical database. Study selection, data extraction, and assessment will be performed independently by 2 researchers. Risk of bias will be assessed with the Cochrane risk of bias assessment tool. ETHICS AND DISSEMINATION Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. TRIAL REGISTRATION NUMBER PROSPERO 2018 CRD42018083857.
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Affiliation(s)
- Jong-In Kim
- Division of Acupuncture & Moxibustion Medicine, Kyung Hee Korean Medicine Hospital, Kyung Hee University, Seoul
| | - Tae-Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Ji Hee Jun
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
| | - Hee Kang
- Graduate School of East-West Medical Science, Kyung Hee University, Yongin, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon
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22
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Abstract
Overactive bladder syndrome (OAB) is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine and was first described in the early 1980s. It is a neuromodulation technique used to modulate bladder function and facilitate storage. Being a minimally invasive, easily applicable, but time-consuming treatment, future developments with implantable devices might be the solution for the logistical problems and economic burden associated with PTNS on the long term. This nonsystematic review provides a current overview on PTNS and its effectiveness in the treatment of OAB for both adults and children.
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Affiliation(s)
- Liesbeth L de Wall
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John Pfa Heesakkers
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
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23
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Abstract
AIMS Percutaneous tibial nerve stimulation (PTNS) is an effective neuromodulation therapy for treating overactive bladder (OAB). The therapeutic effects are achieved by repeatedly applying electrical stimulation through a percutaneous needle electrode that is used to target the tibial nerve (TN). Anatomical studies indicate there can be multiple saphenous nerve (SAFN) branches located near the site of electrical stimulation, and therefore we investigated the possibility of evoking a bladder-inhibitory reflex by electrically activating the SAFN. MATERIALS AND METHODS Acute experiments were conducted in 26 urethane-anesthetized rats. Changes in bladder contraction rate (BCR) and bladder capacity were measured in response to 10-min SAFN stimulation trials. Electrical pulses were applied at 25 µA and at stimulation frequencies between 2 Hz and 50 Hz. RESULTS We report that SAFN stimulation at 20 Hz was most effective at reflexively decreasing the BCR (53.8 ± 5.4% from baseline) and also increasing the bladder capacity (145.8 ± 43.5% from baseline). In contrast, SAFN stimulation at other frequencies yielded inconsistent changes in bladder function. Carry-over effects were minimized by randomizing the sequence of SAFN stimulation trials and also by allowing the bladder to return to the baseline conditions. CONCLUSIONS With notable changes in both the BCR and bladder capacity, our findings provide evidence of a novel bladder-inhibitory reflex in anesthetized rats that is mediated by the SAFN. Further work is needed to determine the clinical relevance of this neural pathway.
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Affiliation(s)
- Zainab Moazzam
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Paul B Yoo
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
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24
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Abstract
The diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) has shifted from organ-specific to a multifactorial, multidisciplinary and individualized approach. Patients with refractory and debilitating symptoms may respond to complementary and alternative medical treatments (CAM). Through CAM therapies, practitioners assist the patient to be at the center of their care, empowering them to be emotionally and physically involved. Multi-disciplinary care, including urology, gynecology, gastroenterology, neurology, psychology, physiotherapy and pain medicine, is also identified to be the crux of adequate management of patients with chronic pelvic pain because of its variable etiology. The purpose of this review is to emphasize these changes and discuss management strategies.
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Affiliation(s)
- Megan Danielle Atchley
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
| | - Nima M Shah
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
| | - Kristene E Whitmore
- 1 Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA ; 2 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19107, USA ; 3 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Pelvic and Sexual Health Institute, Philadelphia, PA 19107, USA
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25
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Kızılyel S, Karakeçi A, Ozan T, Ünüş İ, Barut O, Onur R. Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder. Turk J Urol 2015; 41:208-14. [PMID: 26623150 DOI: 10.5152/tud.2015.94210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. MATERIAL AND METHODS In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. RESULTS All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. CONCLUSION PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail.
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Affiliation(s)
- Sadık Kızılyel
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ahmet Karakeçi
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Tunç Ozan
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - İhsan Ünüş
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Osman Barut
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Rahmi Onur
- Department of Urology, Fırat University Faculty of Medicine, Elazığ, Turkey
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