Percutaneous tibial nerve stimulation maintenance therapy for overactive bladder in women: long-term success rates and adherence

Abstract

Purpose

Our objectives are to (1) identify predictors of treatment success in women with overactive bladder (OAB) after 1 year of percutaneous tibial nerve stimulation (PTNS) maintenance therapy, (2) identify trends in success rates during that 1 year, and (3) assess maintenance treatment adherence.

Materials and methods

A retrospective study of 141 women with OAB was performed with the definition of success based on a Patient Global Impression-Improvement (PGI-I) score of 1 (“very much better”) or 2 (“much better”) or a PGI-I score of 1, 2, or 3 (“a little better”). Multivariable logistic regression was performed to identify factors associated with treatment response and the Cochrane-Armitage trend test to identify changes in the scores over time.

Results

After completing 12 weekly treatments, 141 women initiated maintenance therapy with a mean treatment interval of 29 days. At 1 year, 75/141 (53.2%) had discontinued treatment. Those adherent with treatment had a sustained treatment response, with 66.2% of women reporting a PGI-I score of 1, 2 and 92.3% reporting a PGI-I score of 1, 2, or 3 at 1 year. Considering those women who discontinued maintenance therapy as treatment failures, the success rate of 1 year of maintenance therapy ranged from 30.7%–42.9%. No clinical factors were found to be predictive of maintenance treatment success or failure.

Conclusions

Although an effective treatment for those adherent, discontinuation rates of PTNS maintenance therapy at 1 year are high. Given the low numbers of women referred to maintenance therapy, and the high discontinuation rates, long-term PTNS treatment may be feasible for only a minority of women with OAB.

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Acknowledgements

Su-Jau Yang, PhD, Biostatistician (Kaiser Permanente Southern California, Department of Research & Evaluation).

Funding

This research was supported by a grant from the Regional Research Committee (RRC) of Kaiser Permanente Southern California, RRC grant no. KP-RRC-20170503. The RRC did not take part in the study design, data collection, analysis and interpretation of the data, or writing of the report.

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CE Jung: Project development, data collection, data analysis, manuscript writing/editing.

SA Menefee: Project development, manuscript writing/editing.

GB Diwadkar: Project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Carrie E. Jung.

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CE Jung declares no conflict of interest.

SA Menefee declares no conflict of interest.

GB Diwadkar declares no conflict of interest.

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Jung, C.E., Menefee, S.A. & Diwadkar, G.B. Percutaneous tibial nerve stimulation maintenance therapy for overactive bladder in women: long-term success rates and adherence. Int Urogynecol J (2020). https://doi.org/10.1007/s00192-020-04325-1

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Keywords

  • Overactive bladder
  • Maintenance
  • Neuromodulation
  • Tibial nerve
  • Therapeutics
  • Treatment