European Geriatric Medicine

, Volume 9, Issue 2, pp 249–253 | Cite as

Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults

  • C. HentzenEmail author
  • R. Haddad
  • S. Sheikh Ismaël
  • C. Chesnel
  • G. Robain
  • G. Amarenco
  • GRAPPPA, Clinical research Group of perineal dysfunctions in older adults
Research Paper



The main objective of this retrospective study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment.


All patients aged over 65 years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in two neuro-urology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e., purchase of the device between 3 and 6 months).


A total of 264 patients were included (mean age 74.1 ± 6.5 years; 63.3% of women), of whom 53% had neurogenic OAB. Urinary incontinence was reported by 83.7% of patients and DO was found on urodynamic studies in 154 patients. The overall efficacy of TPTNS was 45.1%. None of the tested factors were significantly predictive of efficacy, especially age (≥ 75 years, p = 0.62), associated stress urinary incontinence (p = 0.69) and presence of DO (p = 0.60), whether neurogenic or not.


TPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. This treatment seems to be a good alternative to antimuscarinics against overactive bladder in older adults.


Overactive bladder Aged Tibial nerve stimulation 



Collaborators for the GRAPPPA, Clinical research Group of perineal dysfunctions in older adults: Gérard Amarenco, Audrey Charlanes, Camille Chesnel, Xavier Deffieux, Brigitte Fatton, Xavier Gamé, Rebecca Haddad, Claire Hentzen, Claude Jeandel, Jacques Kerdraon, Pierre Mares, Matthieu Mezzadri, Anne Claire Petit, Benoit Peyronnet, Gilberte Robain, Jean Marc Vetel.

Compliance with ethical standards

Conflict of interest

The authors have no financial or any other kind of personal conflicts with this paper. GRAPPPA (Clinical research Group of perineal dysfunctions in older adults) was funded in 2013 by Pr G. Amarenco.

Ethical approval

This retrospective study was accepted by the local ethics committee. The study protocol and data collection were conducted in accordance with the ethical standards of the national research committee and with the Declaration of Helsinki.

Informed consent

All patients were advised of the research and not opposed to the use of their anonymized data.


  1. 1.
    Coyne KS, Sexton CC, Bell JA, Thompson CL, Dmochowski R, Bavendam T et al (2013) The prevalence of lower urinary tract symptoms (LUTS) and overactive bladder (OAB) by racial/ethnic group and age: results from OAB-POLL. Neurourol Urodyn 32:230–237. CrossRefPubMedGoogle Scholar
  2. 2.
    Wagner TH, Hu T, Bentkover J, LeBlanc K, Stewart W, Corey R et al (2002) Health-related consequences of overactive bladder. Am J Manag Care 8:S598–S607PubMedGoogle Scholar
  3. 3.
    Lee KS, Choo MS, Seo JT, Oh SJ, Kim HG, Ng K et al (2015) Impact of overactive bladder on quality of life and resource use: results from Korean Burden of Incontinence Study (KOBIS). Health Qual Life Outcomes 13:89. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tang DH, Colayco D, Piercy J, Patel V, Globe D, Chancellor MB (2014) Impact of urinary incontinence on health-related quality of life, daily activities, and healthcare resource utilization in patients with neurogenic detrusor overactivity. BMC Neurol 14:74. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Egberts A, van der Craats ST, van Wijk MD, Alkilabe S, van den Bemt PMLA, Mattace-Raso FUS (2017) Anticholinergic drug exposure is associated with delirium and postdischarge institutionalization in acutely ill hospitalized older patients. Pharmacol Res Perspect 5:e00310. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Green AR, Segal J, Tian J, Oh E, Roth DL, Hilson L et al (2017) Use of bladder antimuscarinics in older adults with impaired cognition. J Am Geriatr Soc 65:390–394. CrossRefPubMedGoogle Scholar
  7. 7.
    Chatterjee S, Carnahan RM, Chen H, Holmes HM, Johnson ML, Aparasu RR (2016) Anticholinergic medication use and risk of pneumonia in elderly adults: a nested case-control study. J Am Geriatr Soc 64:394–400. CrossRefPubMedGoogle Scholar
  8. 8.
    Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES et al (2009) Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 182:1055–1061. CrossRefPubMedGoogle Scholar
  9. 9.
    Booth J, Hagen S, McClurg D, Norton C, MacInnes C, Collins B et al (2013) A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. J Am Med Dir Assoc 14:270–274. CrossRefPubMedGoogle Scholar
  10. 10.
    Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG (2010) Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women. Int Urogynecol J 21:1065–1070. CrossRefPubMedGoogle Scholar
  11. 11.
    Klingler HC, Pycha A, Schmidbauer J, Marberger M (2000) Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology 56:766–771CrossRefPubMedGoogle Scholar
  12. 12.
    Zinkgraf K, Quinn AO, Ketterhagen D, Kreuziger B, Stevenson K (2009) Percutaneous tibial nerve stimulation for treatment of overactive bladder and urinary retention in an elderly population. Urol Nurs 29:30–34PubMedGoogle Scholar
  13. 13.
    Gomes T, Juurlink DN, Mamdani MM (2012) Comparative adherence to oxybutynin or tolterodine among older patients. Eur J Clin Pharmacol 68:97–99. CrossRefPubMedGoogle Scholar
  14. 14.
    Preyer O, Umek W, Laml T, Bjelic-Radisic V, Gabriel B, Mittlboeck M et al (2015) Percutaneous tibial nerve stimulation versus tolterodine for overactive bladder in women: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 191:51–56. CrossRefPubMedGoogle Scholar
  15. 15.
    Peña Ros E, Parra Baños PA, Benavides Buleje JA, Muñoz Camarena JM, Escamilla Segade C, Candel Arenas MF et al (2016) Short-term outcome of percutaneous posterior tibial nerve stimulation (PTNS) for the treatment of faecal incontinence. Tech Coloproctol 20:19–24. CrossRefPubMedGoogle Scholar
  16. 16.
    van der Pal F, van Balken MR, Heesakkers JPFA, Debruyne FMJ, Bemelmans BLH (2006) Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary? BJU Int 97:547–550. CrossRefPubMedGoogle Scholar
  17. 17.
    Monteiro ÉS, de Carvalho LBC, Fukujima MM, Lora MI, do Prado GF (2014) Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: a randomized controlled trial. Urology 84:509–514. CrossRefPubMedGoogle Scholar
  18. 18.
    Finazzi Agrò E, Campagna A, Sciobica F, Petta F, Germani S, Zuccalà A et al (2005) Posterior tibial nerve stimulation: is the once-a-week protocol the best option? Minerva Urol E Nefrol Ital J Urol Nephrol 57:119–123Google Scholar
  19. 19.
    MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC et al (2010) Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol 183:234–240. CrossRefPubMedGoogle Scholar
  20. 20.
    van Balken MR, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM et al (2001) Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol 166:914–918CrossRefPubMedGoogle Scholar
  21. 21.
    Ammi M, Chautard D, Brassart E, Culty T, Azzouzi AR, Bigot P (2014) Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder. Int Urogynecol J 25:1065–1069. CrossRefPubMedGoogle Scholar
  22. 22.
    Amarenco G, Ismael SS, Even-Schneider A, Raibaut P, Demaille-Wlodyka S, Parratte B et al (2003) Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169:2210–2215. CrossRefPubMedGoogle Scholar
  23. 23.
    de Sèze M, Raibaut P, Gallien P, Even-Schneider A, Denys P, Bonniaud V et al (2011) Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol Urodyn 30:306–311. CrossRefPubMedGoogle Scholar
  24. 24.
    Liu Y, Xu G, Luo M, Teng H-F (2016) Effects of transcutaneous electrical nerve stimulation at two frequencies on urinary incontinence in poststroke patients: a randomized controlled trial. Am J Phys Med Rehabil 95:183–193. CrossRefPubMedGoogle Scholar
  25. 25.
    White WM, Mobley JD, Doggweiler R, Dobmeyer-Dittrich C, Klein FA (2009) Sacral nerve stimulation for refractory overactive bladder in the elderly population. J Urol 182:1449–1452. CrossRefPubMedGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2017

Authors and Affiliations

  1. 1.Department of Neuro-urologyTenon Hospital, AP-HPParisFrance
  2. 2.Department of Physical Medicine and RehabilitationRothschild Hospital, AP-HPParisFrance
  3. 3.Clinical Research Group of Perineal Dysfunctions in Older AdultsGRAPPPAParisFrance

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