World Journal of Urology

, Volume 36, Issue 9, pp 1455–1460 | Cite as

Transcutaneous tibial nerve stimulation: 2 years follow-up outcomes in the management of anticholinergic refractory overactive bladder

  • Pierre-Adrien Leroux
  • Elena Brassart
  • Souhil Lebdai
  • Abdel-Rahmène Azzouzi
  • Pierre Bigot
  • Julie Carrouget
Original Article



To evaluate long-term use, efficacy and tolerability of transcutaneous tibial nerve stimulation (TTNS) in the treatment of refractory overactive bladder (OAB).


We performed a prospective observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment, with ≥ 24 months follow-up. The protocol consisted of daily stimulation at home. The primary outcome was treatment persistence. Amelioration was defined as an improvement in urinary symptom profile (USP) score.


We assessed 84 consecutive patients. After a mean follow-up of 39.3 months and a mean treatment use of 8.3 months, almost two-thirds of patients (71.8%) had discontinued TTNS. Treatment continuation was > 12 months for 28 patients (33.3%) and > 18 months for 16 patients (19%). TTNS was successful following 3 months of treatment in 60 (71%) patients. Mean USP score stayed significantly lower than baseline until 12 months of treatment, but was not significant anymore after 18 months. Discontinuation therapy reasons were a lack of sufficient symptom relief for 59 (70%) patients, compliance difficulty for 5 (6%) patients and becoming asymptomatic for 6 (8%) patients. No serious adverse events occurred.


The present study confirms the utility of TTNS as a treatment option for patients with resistant OAB. In the long-term use, few patients continued with therapy, mostly because of a decreased effectiveness with time.


Transcutaneous tibial nerve stimulation Overactive bladder Detrusor overactivity USP 


Author contributions

P-AL: data collection and analysis, and manuscript writing/editing. EB: project development and data collection. SL: manuscript editing. ARA: project development. PB: project development, manuscript editing and data analysis. JC: data analysis and manuscript writing/editing

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Haylen BT, de Ridder D, Freeman RM et al (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 29:4–20. PubMedGoogle Scholar
  2. 2.
    Irwin DE, Milsom I, Hunskaar S et al (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1315CrossRefPubMedGoogle Scholar
  3. 3.
    Madhuvrata P, Cody JD, Ellis G et al (2012) Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 1:CD005429. PubMedGoogle Scholar
  4. 4.
    D’Souza AO, Smith MJ, Miller L-A et al (2008) Persistence, adherence, and switch rates among extended-release and immediate-release overactive bladder medications in a regional managed care plan. J Manag Care Pharm JMCP 14:291–301PubMedGoogle Scholar
  5. 5.
    Abrams P, Andersson KE, Birder L et al (2010) Fourth international consultation on incontinence recommendations of the international scientific committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29:213–240. CrossRefPubMedGoogle Scholar
  6. 6.
    Zinkgraf K, Quinn AO, Ketterhagen D et al (2009) Percutaneous tibial nerve stimulation for treatment of overactive bladder and urinary retention in an elderly population. Urol Nurs 29:30–34PubMedGoogle Scholar
  7. 7.
    Stewart F, Gameiro LF, El Dib R et al (2016) Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Cochrane Database Syst Rev 12:CD010098. PubMedGoogle Scholar
  8. 8.
    Haab F, Richard F, Amarenco G et al (2008) Comprehensive evaluation of bladder and urethral dysfunction symptoms: development and psychometric validation of the urinary symptom profile (USP) questionnaire. Urology 71:646–656. CrossRefPubMedGoogle Scholar
  9. 9.
    De Sèze M, Raibaut P, Gallien P et al (2011) Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol Urodyn 30:306–311. CrossRefPubMedGoogle Scholar
  10. 10.
    Ammi M, Chautard D, Brassart E et al (2014) Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder. Int Urogynecol J 25:1065–1069. CrossRefPubMedGoogle Scholar
  11. 11.
    Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG (2010) Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J 21:1065–1070. CrossRefPubMedGoogle Scholar
  12. 12.
    Govier FE, Litwiller S, Nitti V et al (2001) Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol 165:1193–1198CrossRefPubMedGoogle Scholar
  13. 13.
    Klingler HC, Pycha A, Schmidbauer J, Marberger M (2000) Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology 56:766–771CrossRefPubMedGoogle Scholar
  14. 14.
    Vandoninck V, van Balken MR, Finazzi Agrò E et al (2003) Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn 22:227–232. CrossRefPubMedGoogle Scholar
  15. 15.
    Peters KM, MacDiarmid SA, Wooldridge LS et al (2009) Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 182:1055–1061. CrossRefPubMedGoogle Scholar
  16. 16.
    Peters KM, Carrico DJ, Wooldridge LS et al (2013) Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3 years results of the STEP study. J Urol 189:2194–2201. CrossRefPubMedGoogle Scholar
  17. 17.
    Amarenco G, Ismael SS, Even-Schneider A et al (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169:2210–2215. CrossRefPubMedGoogle Scholar
  18. 18.
    Hashim H, Beusterien K, Bridges JFP et al (2015) Patient preferences for treating refractory overactive bladder in the UK. Int Urol Nephrol 47:1619–1627. CrossRefPubMedGoogle Scholar
  19. 19.
    Souto SC, Reis LO, Palma T et al (2014) Prospective and randomized comparison of electrical stimulation of the posterior tibial nerve versus oxybutynin versus their combination for treatment of women with overactive bladder syndrome. World J Urol 32:179–184. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyAngers University HospitalAngersFrance

Personalised recommendations