SUFU 2019: Real World Compliance With Percutaneous Tibial Nerve Stimulation Maintenance Therapy

Miami, FL ( Percutaneous tibial nerve stimulation (PTNS) is one of the treatment options for patients with voiding dysfunction. Initial prescription is for the 30-minutes weekly therapy sessions over the course of 12 month. Data suggest that maintenance course is important in preserving the therapeutic effect of PTNS, but research on actual compliance with a protocol is unknown.

William Berg, MD, and colleagues aimed to evaluate dropout rates related to the maintenance treatment and indicate possible factors behind patients’ compliance. The study population included 133 patients who received PTNS therapy form January 2014 to August 2017. A total of 96 patients only completed their primary 12-week protocol. Data was analyzed on 69 participants who finished their initial 3-months treatment and continued on their maintenance course of various frequencies. Researchers evaluated participants’ dropout rate at 3, 6, 9, and 12-month points following the completion of the initial treatment and compared their outcomes to the patients with a primary course only. 

Sample size included 49 subjects (20% male vs 80% female) who didn’t complete 12 months of maintenance and 20 subjects (5% male vs 95% female) who did (Figure 1). 

Dropout rate at 3-month evaluation was 72% (50 out of 69), 53% (37 out of 69) at the 6-month checkpoint, 44% (30 out of 69) at the 9-month, and 30% (21 out of 69) at the 12-month follow up (Figure 2).
Figure 2:Dropout from Maintenance

The following non-compliance reasons were identified: patient’s perception that treatment was not effective, lack of time, exploration of other therapy option, and insurance issues. Data analysis showed that self-reported improvement in urinary symptoms (HR=43, p=0.034) and Medicare status (HR=96, p=0.027) are linked to the higher chance of maintenance therapy compliance. Participant’s unemployment was a limiting factor in sustaining PTNS treatment for more than year (HR=0.123, p=0.045). 

Research showed that patients’ perception of treatment effectiveness, insurance status, and employment are factors behind improved maintenance therapy compliance. Almost half of the study patients discontinued treatment after 7 months post initial protocol due to such common reasons as lack of time and improvement. Future studies are needed to investigate risk factors behind decreased compliance with the continuation of the treatment.

Presented by: William T. Berg, MD, Stony Brook University, Department of Urology

Co-authors: Chris Du, BA, Stony Brook School of Medicine, Zhenyue Huang, BA, Stony Brook School of Medicine Alexandra Siegal, BA, Stony Brook School of Medicine Steven Weissbart, MD, Stony Brook University, Department of Urology, Jason Kim, MD, Stony Brook University, Department of Urology

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