Authors: (including presenting author): :
NC Mr Chu SF (1)
Members of SAG Urology Nursing Subgroup (2)
Affiliation: :
(1)Department of Surgery, Princess Margaret Hospital
(2)SAG Urology Nursing Subgroup, Hospital Authority
Keyword 1: :
tibial nerve stimulation
Keyword 3: :
overactive bladder
Introduction: :
Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive neuromodulation therapy designed to treat overactive bladder (OAB) symptoms, including urinary urgency, frequency, and incontinence. PTNS holds clinical significance as it provides a viable alternative for patients who have not responded to traditional treatments, effectively improving their quality of life without resorting to surgical interventions. The typical treatment protocol involves 12 weekly sessions of electrical stimulation delivered to the tibial nerve, which modulates bladder activity by influencing the sacral nerve plexus. While the American Urological Association (AUA) guidelines recommend maintenance therapy following the initial PTNS treatments, there is currently no standardized protocol outlining the frequency and optimal regimen for this maintenance phase.
Objectives: :
The aim of our project is to evaluate the most effective maintenance regimen for PTNS to sustain symptom improvement in patients with overactive bladder.
Methodology: :
A comprehensive literature search was conducted using databases such as Embase, Medline, UpToDate, CINAHL, Cochrane Library, PubMed, and Google Scholar. We selected relevant randomized controlled trials (RCTs) and prospective studies, and each paper was assessed for the level of evidence using the Johns Hopkins Quality Appraisal Tool.
Result & Outcome: :
Results
A total of eight studies were identified, all of which employed a monthly maintenance regimen for PTNS sessions. The duration of the maintenance phase varied between six to twelve months. All studies indicated sustainable improvements in OAB symptoms with regular maintenance PTNS treatment. Among these studies, two investigated alternative maintenance schedules, including every two weeks or on an as-needed basis (ranging from two to twelve weeks), based on patients' conditions or preferences. Notably, there were no significant differences in symptom bother or patient satisfaction between the monthly and PRN (as-needed) groups.
Additionally, three of the eight studies implemented tapering sessions following the initial twelve-week induction period, employing various arrangements. However, only one study demonstrated a significant benefit from tapering, showing a 56% further reduction in urinary frequency. Conclusion
The findings suggest that while regular PTNS sessions are beneficial, the monthly maintenance regimen is the prevailing approach for sustaining symptom relief. Variations in maintenance frequency and the effects of tapering necessitate further investigation to better understand their impact on patient outcomes. As PTNS continues to evolve, a standardized protocol for maintenance therapy may enhance the treatment’s effectiveness and patient adherence.
