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Correlation between quality of life and voiding variables in patients with refractory overactive bladder syndrome treated with percutaneous tibial nerve stimulation
Marybeth Singh, NP, John F. Bresette, MD, John T. Stoffel, MD, Arthur Mourtzinos, MD.
Lahey Clinic Medical Center, Burlington, MA, USA.

BACKGROUND: Conservative treatment of overactive bladder (OAB) syndrome usually comprises behavioral techniques, bladder retraining, pelvic floor re-education and pharmacotherapy but up to 30% of patients will remain refractory to treatment. Inhibition of detrusor activity by peripheral neuromodulation of the posterior tibial nerve was first described in 1983, with recent authors further confirming a 60-80% positive response rate. This retrospective analysis evaluated the application of percutaneous tibial nerve stimulation (PTNS), a minimally invasive neuromodulation therapy, in a population of patients who failed to achieve adequate control of symptoms of urinary urgency, urinary frequency, and urinary incontinence with conservative treatments and were not candidates for sacral neuromodulation. We sought to investigate the relationship between quality of life (QoL) and voiding variables in patients with lower urinary tract dysfunction treated with (PTNS)
METHODS: Fifteen patients with refractory OAB (more than seven voids and/or three or more urge incontinence episodes per day) were successfully treated with PTNS. Patients completed 24 hour bladder diaries and quality-of-life (QoL) questionnaires (the Incontinence Impact Questionnaire and Urogenital Distress Inventory) at baseline and after PTNS. A course of 12 PTNS sessions was prescribed and administered for each patient.
RESULTS: After 12 weeks of therapy PTNS patients had significant improvements in frequency, nighttime voids, voids with moderate to severe urgency and urinary urge incontinence episodes which correlated with improvements in the QoL patient questionnaires. No serious device related adverse events or malfunctions were reported.
CONCLUSIONS: PTNS is useful for treating refractory OAB symptoms and should at least be considered as a therapeutic alternative before resorting to aggressive surgery, as voiding and QoL variables significantly correlate in patients with refractory OAB who are treated with PTNS. Further studies are needed to set up parameters for maintenance therapy in this difficult and unfortunate group of patients.


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