Comparison of transcutaneous tibial nerve stimulation (TTNS) protocols for women with refractory overactive bladder (OAB): A prospective randomised trial

Abstract

Objectives Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. Methods A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30 minutes for 12 weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB‐V8/ICIQ‐SF scores and voiding frequencies recorded in the bladder diary were compared between groups. Results Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB‐V8, ICIQ‐SF scores in both group 1 and group 2 (P < .001). A significant decrease in the OAB‐V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12 weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12‐week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. Conclusion TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week.

Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rat menopause model

“…It is possible that changing stimulation frequency could affect output, as demonstrated by the frequency-dependent effects of PTNS on the bladder (6-20 Hz is inhibitory, while 2 Hz is excitatory) [31]. Stimulation more frequently than twice a week may lead to greater or faster improvement, as suggested by clinical studies for fecal incontinence [32] and overactive bladder [33]. It is possible that bilateral PTNS could increase treatment efficacy; bilateral tibial nerve stimulation has been shown to be effective for constipation [34,35] and overactive bladder [36].…”

Physical Agent-Based Treatments for Overactive Bladder: A Review

“…T-TNS can be performed on one or both legs for 30 min The initial session takes place in a hospital, but subsequent regimens can be completed at home [ 53 ].…”

“…The frequency of stimulation (once or twice a week) had a no significant effect on the effectiveness of lowering OAB symptoms [ 55 ]. Moreover, Alkis et al [ 53 ] found that a three-times-a-week treatment resulted in a more-rapid decrease in OAB symptoms compared to a once-a-week treatment.…”

“…In recent years, some companies have developed novel ambulatory T-TNS devices. T-TNS can be performed by the patient or their family at home after receiving suitable training [ 53 ]. Patients do not have to go to a hospital as often, which is expected to encourage them in continuing a longer-term treatment.…”

How effectively do we apply first-line treatment in overactive bladder?

“…Furthermore, in addition to behavioral therapy, pelvic floor muscle training (PFMT) and antimuscarinic and/or beta3-agonist therapy may be implemented in the first-line treatment [5,6]. Patients who were nonrespondent to the first-line treatment may undergo therapeutic methods such as intravesical botulinum toxin administration, posterior tibial nerve stimulation, and sacral neuromodulation [7].…”