Comparison of the Effect of Percutaneous Tibial Nerve Stimulation (PTNS) with Medical Treatment in Patients with Overactive Bladder

Introduction: Overactive bladder (OAB) is a common problem that involves therapeutic challenges. Therefore, finding new and effective treatment modalities in these patients is essential. The aim of this study was to compare the therapeutic effect of percutaneous tibial nerve stimulation (PTNS) with drug therapy in patients with OAB. Methods: In this randomized controlled clinical trial, 74 patients with OAB were randomly divided into two groups: PTNS (twice a week for 12 weeks) and drug treatment (Solifenacin 10 mg daily for 12 weeks). OAB Symptom Score, q-OAB and Health-Related Quality of Life Questionnaire (HRQL) were completed and then compared at the beginning and end of the study for the two groups. Findings were analyzed using SPSS software version 20. Results: The drug intervention group consisted of 33 (89.2%) females and 4 males (10.81%), and PTNS group consisted of 31 females (83.8%) and 6 males (16.21%), (P = 0.496). Mean quality of life score, mean OABSS score, OAB screening score and urinary incontinence in both groups before the intervention did not show a statistically significant difference. After treatment, the mean quality of life in both groups increased significantly compared to before the intervention, but this increase was significantly higher in PTNS when compared with other group (74.2±6.9 vs. 68.9± 7.3). The mean OABSS score, OAB screening score and urinary incontinence in both groups decreased significantly compared to before treatment, but the mean OABSS score and OAB and urinary incontinence screening scores showed a significant decrease in PTNS group compared to drug treatment. Conclusion: Based on the findings, PTNS was found to be more effective than drug treatment in increasing the quality of life and controlling symptoms of OAB.

Percutaneous Tibial Nerve Stimulation in Chronic Post-Surgical Anorectal Pain: A Case Report

<b><i>Introduction:</i></b> Anorectal pain is a symptom with a negative impact on quality of life and it can sometimes develop into a chronic pain syndrome. Structural anorectal pain is treated according to the underlying pathology. In situations of chronic post-surgical pain that is refractory to conventional therapeutic approaches, percutaneous tibial nerve stimulation (PTNS) is an option. PTNS is a neurostimulation technique used in the treatment of lower urinary tract dysfunction. There has been increasing evidence of its benefits for improving other conditions, such as chronic pelvic pain (CPP) and faecal incontinence (FI). <b><i>Case Presentation:</i></b> We report a case of a 45-year-old woman with chronic post-surgical anorectal pain (CPAP) treated with PTNS. The patient reported a consistent and dramatic decrease in both the frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D-3L questionnaires. <b><i>Discussion:</i></b> Neuromodulation treatments have been reported as effective for anorectal pain, but reports on the use of PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anaesthesia. The overall improvement observed in this case of chronic anorectal pain suggests a potential new area of research for PTNS.

Clinical efficacy of transcutaneous tibial nerve stimulation (TTNS) versus sham therapy (part I) and TTNS versus percutaneous tibial nerve stimulation (PTNS) (part II) on the short term in children with the idiopathic overactive bladder syndrome: protocol for part I of the twofold double-blinded randomized controlled TaPaS trial

Background Transcutaneous tibial nerve stimulation (TTNS) and percutaneous tibial nerve stimulation (PTNS) are effective and safe therapies for overactive bladder (OAB) syndrome in adults. However, few randomized sham-controlled trials have been conducted in a pediatric population. To our knowledge, both therapies never have been compared in children. Aim The aim of the complete study is twofold: (1) to assess the efficacy of TTNS therapy on bladder symptoms after 12 weeks of treatment in a pediatric population with idiopathic overactive bladder syndrome (iOAB) and/or nocturnal enuresis (part I) and (2) to assess the effect of TTNS compared to PTNS (part II). In this article, we aim to present the protocol of the first part of the TaPaS trial (TTNS, PTNS, sham therapy). Methods Part I of the TaPaS trial is set up as a single-center randomized-controlled trial. Children, aged from 5 to 12 years with iOAB and/or nocturnal enuresis, are assigned to two groups by computer-generated randomization: TTNS therapy (intervention) and sham therapy (control). The primary outcome is the percentage difference in average voided volume (AVV) between baseline and after 12 weeks of treatment. Secondary endpoints are the percentage difference in supervoid volumes, number of urinary incontinence episodes/24 h and in voiding frequency, the difference in parent reported outcomes between baseline and after 12 weeks of treatment, and the duration of clinical response. Discussion We hypothesize that TTNS is a non-inferior treatment for iOAB in children compared to PTNS therapy. Since literature is inconclusive about the efficacy of TTNS in a pediatric population, a sham-controlled RCT on TTNS will be conducted (part I). A protocol for a prospective randomized sham-controlled trial has been developed. Enrolment has started in November 2018. Study completion of part I is expected by August 2021. Trial registration ClinicalTrials.gov NCT 04256876. Retrospectively registered on February 5, 2020.