Factors influencing return for maintenance treatment with Percutaneous Tibial Nerve Stimulation for the management of the overactive bladder.

To identify factors influencing return for maintenance Percutaneous tibial nerve stimulation (PTNS) treatment after successful completion of a 12-week course of treatment for the overactive bladder (OAB).

Patients with OAB symptoms referred for PTNS treatment underwent twelve sessions of weekly PTNS treatment and evaluated at baseline and week 12 using the International Consultation on Incontinence Questionnaire on OAB (ICIQ-OAB), lower urinary tract symptoms related quality of life questionnaire (ICIQ-LUT symptoms QOL) and bladder diary (BD). Responders to treatment, evaluated using two patient-reported outcome measurements, were invited to return for maintenance treatments when symptoms returned. A PTNS Service Evaluation Questionnaire (PTNS-SEQ) was used to evaluate factors influencing return for maintenance treatment.

79 patients were evaluated (mean age 58.9 (±14.7), female 72.6%) and clustered into three groups - group 1 (n=28) did not respond to 12 weekly sessions of PTNS treatment; group 2 (n=28) responded to treatment but did not return for maintenance treatment and group 3 (n=31) responded to treatment and returned for maintenance treatment. There were no significant differences in demographic characteristics, diagnosis, baseline symptom scores and BD parameters between the three groups. Patients belonging to groups 2 and 3 experienced a significant improvement from baseline to week 12 in total OAB scores (group 2: -1.54 ± 1.85; group 3: -1.85 ± 2.28, p<0.05). However, patients returning for maintenance treatment reported significant improvements specifically in nocturia (BD difference = -0.4 ± 0.7, p<0.05 and ICIQ-LUT symptoms QOL difference -0.48 ± 0.94, p<0.05), and perceived benefits of the treatment on their OAB symptoms compared to those not returning for maintenance treatment (difference between the two groups = 25.6%, p=0.030). Improvements in nocturia and perceived benefits predicted return for maintenance treatment through a logistic regression analysis. Factors related to the need for attending repeat clinic visits such as transportation, distance and time commitment were not found to differ between the two groups.

Twelve-session weekly PTNS is a safe and effective treatment for OAB. Responders to treatment returning for maintenance PTNS more often reported significant improvements in nocturia and perceived benefits over time, compared to those not returning for maintenance treatment. The bladder diary provides a more objective assessment of treatment outcome following PTNS treatment. This article is protected by copyright. All rights reserved.

BJU international. 2018 Dec 15 [Epub ahead of print]

Janek Salatzki, Martina D Liechti, Eleonora Spanudakis, Gwen Gonzales, Joanne Baldwin, Collette Haslam, Mahreen Pakzad, Jalesh N Panicker

Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, and UCL Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom.