Authors (including presenting author) :
Kam YC, PY Hui, PC Chan, HC To
Affiliation :
Urology Nurse Clinic, Department of Surgery, Queen Elizabeth Hospital.
Introduction :
Overactive bladder (OAB) syndrome is urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection. It is a common urological condition with significant psychosocial implications. Symptoms may decrease quality of life (QoL), increase social isolation and result in increased morbidity. Population-based studies have reported prevalence rates ranging from 16.6% to 24.7% with 40% of patients failing to respond to first- and second-line interventions and thus, requiring escalation to third-line treatments. The therapeutic approach, percutaneous tibial nerve stimulation (PTNS), is recommended only when bladder training (BT) combined with pharmacological regimens has failed. PTNS is a peripheral neuromodulation technique, in which the nervus tibialis (L4-S3) is electrically stimulated above the inner ankle. According to the European Association Urology guidelines for urinary incontinence in adults, PTNS is effective for improving urgency urinary incontinence in women who have had no benefit from antimuscarinic medication.
Objectives :
To investigate the efficacy and safety of Percutaneous Tibial Nerve Stimulation (PTNS) treatment on patients who were referred to Urology Nurse Clinic in the management of storage symptoms with pharmacological regimens have failed.
Methodology :
All patients who were referred to the Urology Nurse Clinic for PTNS from Jan 2019 to Dec 2021 were retrospectively reviewed. The baseline demographic data, age & sex, pre-treatment status and cystometrogram were reviewed. At the 4th, 8th and 12th treatment the patients were assessed by their symptoms progression, bladder diary, urgency incontinence (UUI) episodes, nocturia and day frequency. Patients’ subjective improvement on OAB, frequency, urgency & nocturia were also assessed. The post PTNS complications were also reviewed.
Result & Outcome :
Results: There were 17 patients included for analysis with mean age of 64 years old (9 Male & 8 Female). After 12 weeks of PTNS treatments, the UUI episodes of these patients decreased from 7 times/week to 1 time/week (p=0.001), nocturia episodes decreased from 3 times/ night to 1.5/ night (p=0.001), day frequency decreased from 11 times/ day to 6.5 times/day (p=0.002), maximum voided volume decreased from 220ml/ void to 250ml/void (p=0.068). Patients’ subjective improvement on OAB, frequency, urgency & nocturia are 45%, 35%, 45% and 50% respectively. One patient (6%) reported skin itchiness with Tegaderm (Clavien-Dindo Grade I complication). The efficacy of the treatment was observed 4-8 weeks after interventions. Conclusion: PTNS treatment done by Urology Nurses can effectively decrease the UUI episodes, nocturia and day frequency and improved their quality of life. For those non-respondents after 8-week treatment, termination of treatment can be considered if no subjective improvement is reported.
