Patient-tailored healthcare and tibial nerve neuromodulation in the treatment of patients with overactive bladder symptoms.

The aim of this study was to demonstrate features predictive of treatment response for patient-tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors.

This study was designed as a follow-up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system). For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow-up visits.

We obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered a statistically significant prediction factor (p = 0.042). A statistically significant increase in mean treatment level was seen in the responder group during the 3 month follow-up visit (mean: 6.7 mA, SD 0.416) as compared with the initial system activation visit (mean: 5.8 mA, SD 0.400) (p = 0.049). No other visits demonstrated statistically significant changes in both groups (responders and nonresponders) during the defined timepoints.

This data underscores the need to use patient-tailored OAB treatment. BMI was found to be a negative predictive factor for treatment success. However, it was not possible to develop a specific responder model. A model predicting response to treatment could be useful for implementing shared decision making.

Neurourology and urodynamics. 2022 Jan 12 [Epub ahead of print]

Manon Te Dorsthorst, Alex Digesu, Philip van Kerrebroeck, Sohier Elneil, Jetske van Breda, Dick Janssen, Frank Martens, Michael van Balken, John Heesakkers

Department of Urology, RadboudUMC, Nijmegen, The Netherlands., Department of Urogynaecology, Imperial College NHS Healthcare, London, UK., Department of Urology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands., Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, UK., Department of Urology, UMC Utrecht, Utrecht, The Netherlands., Department of Urology, Rijnstate, Arnhem, The Netherlands.

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