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8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder

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A Commentary to this article was published on 11 December 2019

Abstract

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.

Methods

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.

Results

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]).

Conclusions

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.

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Acknowledgements

Su-Jau Yang, PhD, biostatistician (Kaiser Permanente Southern California Department of Research & Evaluation).

Funding

This research was supported by a grant from the Regional Research Committee of Kaiser Permanente Southern California (RRC grant number: KP-RRC-20170503).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology; Division of Urogynecology, Kaiser Permanente, Southern California, San Diego, CA, USA

    Carrie E. Jung, Shawn A. Menefee & Gouri B. Diwadkar

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, 3250 Fordham Street, San Diego, CA, 92110, USA

    Carrie E. Jung, Shawn A. Menefee & Gouri B. Diwadkar

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  1. Carrie E. Jung
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  2. Shawn A. Menefee
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  3. Gouri B. Diwadkar
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Correspondence to Carrie E. Jung.

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Jung, C.E., Menefee, S.A. & Diwadkar, G.B. 8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder. Int Urogynecol J 31, 905–914 (2020). https://doi.org/10.1007/s00192-019-04191-6

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  • DOI: https://doi.org/10.1007/s00192-019-04191-6

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