8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder
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Introduction and hypothesis
The primary objective is to compare weekly success rates after 8 vs 12 weekly percutaneous tibial nerve stimulation (PTNS) sessions for treatment of overactive bladder (OAB) in women and the secondary objective is to identify treatment response predictors.
A retrospective study of 470 women was performed with the primary definition of success a Patient Global Impression-Improvement (PGI-I) score of 1 (“very much better”) or 2 (“much better”) and a ≥ 10-point improvement in both subscales of the Overactive Bladder Questionnaire-Short Form (OABq-SF). Additional analyses were performed to include a success definition of a PGI-I score of 3 (“a little better”). Categorical variables were compared using the Chi-squared test. Multivariate logistic regression was performed to identify factors associated with response.
One hundred and thirty-six out of 470 (29%) discontinued treatment before 12 weeks. One hundred out of 334 (29.9%) were successes at 8 weeks vs 138 out of 334 (41.3%) at 12 weeks (p = 0.002). Including a PGI-I score of 3 as an indicator of success, 181 out of 334 (54.2%) at 8 weeks and 202 out of 334 (60.5%) at 12 weeks were successes (p = 0.10). Factors associated with treatment response were neurological disorder (OR 4.32 [1.10–16.04]), prolapse surgery history (OR 3.89 [1.12–14.49]), and vaginal estrogen use (OR 1.76 [1.01–3.08]). Recurrent UTI was associated with failure (OR 0.42 [0.21–0.86]).
The PTNS treatment success rate for OAB in women is greater at 12 weeks than at 8 weeks based on two validated questionnaires, the PGI-I and the OABq-SF. However, the success rates were equivalent if women who are “a little better” are also considered successes; with this definition, clinicians may consider shortening treatment duration to 8 weeks. Four clinical factors were significantly associated with response and may help to guide patient selection.
KeywordsOveractive bladder Neuromodulation Tibial nerve Therapeutics
Su-Jau Yang, PhD, biostatistician (Kaiser Permanente Southern California Department of Research & Evaluation).
This research was supported by a grant from the Regional Research Committee of Kaiser Permanente Southern California (RRC grant number: KP-RRC-20170503).
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
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