SUFU 2019: A Randomized Trial of Transcutaneous Nerve Stimulation for Neurogenic Bladder Patients

Miami, FL ( Many therapy options are available for the treatment of urgency and detrusor overactivity, but some of them are ineffective for neurogenic bladder and OAB. Percutaneous tibial nerve stimulation (PTNS) is well recognized as a therapy for OAB, but limited data are available about transcutaneous tibial nerve stimulation (TTNS). A randomized control trial was conducted to evaluate the effects of TTNS for patients with neurogenic bladder (arm 1) and OAB (arm 2).

The study population included adult men and women with either neurogenic bladder or overactive bladder symptoms who failed previous behavioral and/or pharmacological management.  Participants’ perception of bladder condition was a primary outcome of the trial. 

A total number of 48 subjects were enrolled in the study (28 participants with neurogenic bladder (64% female) and 20 with OAB (100% female)). Both study groups have received 30-minute sessions three times per week for the duration of 12 to 13 weeks. Participants were instructed to apply TTNS at home unilaterally. Those who received a sham device were told to place their unit to the lateral aspect of the lower leg. Researchers have checked a study blinding success by asking patients with TENS and sham devices about their perceived group assignment, which showed no correlation.

The study didn’t demonstrate a significant difference between active treatment and sham devices (Figure 1).

There was no significance in secondary patient-reported outcomes: urinary symptoms and NBSS score in neurogenic bladder patients. 

According to Blayne Welk, MD there is a number of RCTs assessing TTNS effectiveness, but they are small, underpowered, and at high risk for bias. Recent data show that TTNS is non-inferior to PTNS, but more research is needed to standardize TTNS techniques. 

Presented by: Blayne Welk, MD, MSc. Western University.

Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania, Twitter: @AStambakio at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida