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 non-invasive method used in OAB treatment. We aimed to compare the effectiveness of the once a week and three times a week TTNS procedure in women diagnosed with wet type refractory OAB. Methods: A total of 60 patients diagnosed with wet type OAB was refractory to medical treatment included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a time duration of 30 minutes for 12 weeks, once a week to Groıp-I and three times a week to Group-II. Pre and post-treatment 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<0.001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group-1, and on 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].…”

Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines

“…PTNS can be safely used before invasive treatment in resistant OAB, and it was more effective if used three times a week than performing it once a week in refractory OAB patients [ 78 – 82 ].…”

Physical and Rehabilitation Therapy for Overactive Bladder in Women: A Systematic Review and Meta-Analysis

“…Te therapies included in this network meta-analysis all improved symptoms of OAB, with therapy durations ranging from 8 to 12 weeks; however, according to existing studies, most of these improvements were time-limited, and symptoms of OAB gradually worsened as treatment was stopped for longer [25,32,35,36]. Te efective control of OAB in the long term is worthy of further study, including physical and rehabilitation therapies, such as BT, behavioral therapy, PFMT, and TTNS, which can be independently treated at home [31,35,37], but PTNS, BF, and ES, etc., need to be carried out by professionals in medical institutions with professional equipment [4,21,30,33]. PTNS, BT + ES, and BT + BF + ES can be the priority therapy when circumstances permit.…”