Urodynamic parameters as predictors of percutaneous tibial nerve stimulation outcomes in overactive bladder patients
DOI:
https://doi.org/10.13181/mji.oa.257836Keywords:
overactive bladder, percutaneous nerve stimulation, tibial nerve, urodynamicAbstract
BACKGROUND Percutaneous tibial nerve stimulation (PTNS) is an emerging overactive bladder (OAB) treatment. However, some patient characteristics can affect its effectiveness. Urodynamic studies help diagnose OAB by evaluating bladder function. This study aimed to identify prognostic factors for PTNS treatment based on urodynamic parameters.
METHODS A retrospective study was performed on 108 patients with OAB who underwent PTNS at Persahabatan Hospital, Jakarta, Indonesia, between January 2022 and January 2023. Patients with primary OAB received an 8-week PTNS regimen and were grouped into success and failure. Pre-treatment urodynamic parameters were extracted and compared between groups. Additional multivariate Cox regression analysis was performed to identify risk factors associated with PTNS failure.
RESULTS Of 108 patients (mean age: 51.69 [17.5]), 77 (73.1%) responded favorably to PTNS treatment. Three significant covariates of PTNS failure were identified: initial sensation volume (hazard ratio [HR]: 6.312; 95% confidence interval [CI]: 1.94−20.49), detrusor overactivity (DO) (HR: 8.476; 95% CI: 1.89−38.095), and infravesical obstruction (IVO) (HR: 5.213; 95% CI: 1.40−19.41).
CONCLUSIONS Urodynamic predictors including abnormal first sensation volume, DO, and IVO were observed as risk factors for PTNS failure. These findings can help medical professionals personalize PTNS treatment, enhancing patient outcomes and satisfaction.
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Alappattu M, Neville C, Beneciuk J, Bishop M. Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services. Physiother Theory Pract. 2016;32(2):107-12. https://doi.org/10.3109/09593985.2015.1116648
Drake MJ. Fundamentals of terminology in lower urinary tract function. Neurourol Urodyn. 2018;37(S6):S13-9. https://doi.org/10.1002/nau.23768
Serati M, Andersson KE, Dmochowski R, Agrò EF, Heesakkers J, Iacovelli V, et al. Systematic review of combination drug therapy for non-neurogenic lower urinary tract symptoms. Eur Urol. 2019;75(1):129-68. https://doi.org/10.1016/j.eururo.2018.09.029
Wang M, Jian Z, Ma Y, Jin X, Li H, Wang K. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J. 2020;31(12):2457-71. https://doi.org/10.1007/s00192-020-04429-8
Al-Danakh A, Safi M, Alradhi M, Almoiliqy M, Chen Q, Al-Nusaif M, et al. Posterior tibial nerve stimulation for overactive bladder: mechanism, classification, and management outlines. Parkinsons Dis. 2022;2022:2700227. https://doi.org/10.1155/2022/2700227
Sonmez R, Yildiz 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. 2022;65(1):101486. https://doi.org/10.1016/j.rehab.2021.101486
Abdel-Fattah M, Chapple C, Cooper D, Breeman S, Bell-Gorrod H, Kuppanda P, et al. Invasive urodynamic investigations in the management of women with refractory overactive bladder symptoms (FUTURE) in the UK: a multicentre, superiority, parallel, open-label, randomised controlled trial. Lancet. 2025;405(10484):1057-68. https://doi.org/10.1016/S0140-6736(24)01886-5
Kubota Y, Kojima Y, Shibata Y, Imura M, Kohri K, Sasaki S. Correlation between improvements in overactive bladder symptom score and health-related quality of life questionnaires in overactive bladder patients treated with an antimuscarinic drug. Neurourol Urodyn. 2011;30(7):1309-14. https://doi.org/10.1002/nau.21065
Gotoh M, Homma Y, Yokoyama O, Nishizawa O. Responsiveness and minimal clinically important change in overactive bladder symptom score. Urology. 2011;78(4):768-73. https://doi.org/10.1016/j.urology.2011.06.020
Widia F, Indraswari MT, Rahardjo HE. Characteristics of neurogenic lower urinary tract dysfunction patients at Cipto Mangunkusumo Hospital. Med J Indones. 2023;32(1):31-7. https://doi.org/10.13181/mji.oa.236605
Corcos J, Przydacz M, Campeau L, Gray G, Hickling D, Honeine C, et al. CUA guideline on adult overactive bladder. Can Urol Assoc J. 2017;11(5):E142-73. Erratum in: Can Urol Assoc J. 2017;11(5):E250. https://doi.org/10.5489/cuaj.4586
Iyer S, Laus K, Rugino A, Botros C, Lozo S, Botros SM, et al. Subjective and objective responses to PTNS and predictors for success: a retrospective cohort study of percutaneous tibial nerve stimulation for overactive bladder. Int Urogynecol J. 2019;30(8):1253-9. https://doi.org/10.1007/s00192-018-3822-0
Tudor KI, Seth JH, Liechti MD, Ochulor J, Gonzales G, Haslam C, et al. Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder. Clin Auton Res. 2020;30(1):61-7. https://doi.org/10.1007/s10286-018-0553-8
Wibisono E, Rahardjo HE. Management of overactive bladder review: the role of percutaneous tibial nerve stimulation. Med J Indones. 2016;25(4):245-54. https://doi.org/10.13181/mji.v25i4.1385
Rostaminia G, Chang C, Pincus JB, Sand PK, Goldberg RP. Predictors of successful percutaneous tibial nerve stimulation (PTNS) in the treatment of overactive bladder syndrome. Int Urogynecol J. 2019;30(10):1735-45. https://doi.org/10.1007/s00192-018-3834-9
Hentzen C, Chesnel C, Lagnau P, Blouet E, Teng M, Amarenco G. Transcutaneous tibial nerve stimulation in patients with multiple sclerosis and overactive bladder: a real-life clinical and urodynamic assessment. World J Urol. 2024;42(1):136. https://doi.org/10.1007/s00345-024-04836-2
de Wall LL, Heesakkers JP. Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Res Rep Urol. 2017;9:145-57. https://doi.org/10.2147/RRU.S124981
Theisen K, Browning J, Li X, Li S, Shen B, Wang J, et al. Frequency dependent tibial neuromodulation of bladder underactivity and overactivity in cats. Neuromodulation. 2018;21(7):700-6. https://doi.org/10.1111/ner.12792
Yao M, Simoes A. Urodynamic testing and interpretation. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing; 2025 [cited 2023 Nov 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562310/.
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