Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder

This study evaluated the efficacy and tolerability of transcutaneous posterior tibial nerve stimulation (TPTNS) in the treatment of overactive bladder (OAB) after failure of a first-line anticholinergic treatment. We performed a prospective observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment from November 2010 to May 2013. The protocol consisted of daily stimulation at home. The efficacy end point was defined as improvement on the Urinary Symptom Profile (USP) and the French-validated urinary symptom score Mesure du Handicap Urinaire (MHU). We assessed 43 consecutive patients. TPTNS was successful following 1 month of treatment in 23 (53 %) patients. Bladder capacity was the only predictive factor for treatment success (p = 0.044). For patients who showed improved symptoms (n = 23; 53 %), mean MHU and USP decreased significantly, from 11.8 +/- 2.8 to 5.6 +/- 3 (p < 0.001) and from 14 +/- 3.3 to 6.9 +/- 3.2 (p < 0.001), respectively. After a mean follow-up of 10.8 +/- 1.6 months, 21 (49 %) patients continued the TPTNS. Mean MHU and USP scores were 4.4 +/- 2.8 and 5.4 +/- 3.5, respectively, and stayed lower than baseline (p < 0.001). Patients reported no adverse events. TPTNS is well tolerated and is effective in one half of the patients studied after they failed anticholinergic treatment. TPTNS could become a second therapeutic option before surgical treatment in the management strategy of OAB.