Percutaneous Tibial Nerve Stimulation for the Long-Term Treatment of Overactive Bladder: 3-Year Results of the STEP Study

Peters, Kenneth M.; Carrico, Donna J.; Wooldridge, Linda; Miller, Christopher J.; MacDiarmid, Scott

doi:10.1016/j.juro.2012.11.175

Cited by 173 publications

(129 citation statements)

References 25 publications

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“…46 At three years, they found 77% (95% CI=64%-90%) of subjects with maintained or marked OAB improvements. 47 All in all, PTNS is durable and can be a long-term treatment option for OAB.…”

Section: 44mentioning

confidence: 99%

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Wibisono

Rahardjo

2017

Med J Indones

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ABSTRAK ABSTRACTOveractive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients' quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration.

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“…46 At three years, they found 77% (95% CI=64%-90%) of subjects with maintained or marked OAB improvements. 47 All in all, PTNS is durable and can be a long-term treatment option for OAB.…”

Section: 44mentioning

confidence: 99%

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Wibisono

Rahardjo

2017

Med J Indones

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“…A major clinical benefit of TNS is the long-lasting poststimulation inhibitory effect, which allows for the sustained improvement in OAB symptoms by a 30-min stimulation once a month following completion of an initial 12-wk treatment (21). A 30-min TNS in cats has also been shown to produce a sustained poststimulation inhibition lasting for hours (27).…”

mentioning

confidence: 99%

Role of the brain stem in tibial inhibition of the micturition reflex in cats

Ferroni

Slater

Shen

et al. 2015

American Journal of Physiology-Renal Physiology

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This study examined the role of the brain stem in inhibition of bladder reflexes induced by tibial nerve stimulation (TNS) in ␣-chloralose-anesthetized decerebrate cats. Repeated cystometrograms (CMGs) were performed by infusing saline or 0.25% acetic acid (AA) to elicit normal or overactive bladder reflexes, respectively. TNS (5 or 30 Hz) at three times the threshold (3T) intensity for inducing toe movement was applied for 30 min between CMGs to induce post-TNS inhibition or applied during the CMGs to induce acute TNS inhibition. Inhibition was evident as an increase in bladder capacity without a change in amplitude of bladder contractions. TNS applied for 30 min between saline CMGs elicited prolonged (Ͼ2 h) poststimulation inhibition that significantly (P Ͻ 0.05) increased bladder capacity to 30 -60% above control; however, TNS did not produce this effect during AA irritation. TNS applied during CMGs at 5 Hz but not 30 Hz significantly (P Ͻ 0.01) increased bladder capacity to 127.3 Ϯ 6.1% of saline control or 187.6 Ϯ 5.0% of AA control. During AA irritation, naloxone (an opioid receptor antagonist) administered intravenously (1 mg/kg) or directly to the surface of the rostral brain stem (300 -900 g) eliminated acute TNS inhibition and significantly (P Ͻ 0.05) reduced bladder capacity to 62.8 Ϯ 22.6% (intravenously) or 47.6 Ϯ 25.5% (brain stem application). Results of this and previous studies indicate 1) forebrain circuitry rostral to the pons is not essential for TNS inhibition; and 2) opioid receptors in the brain stem have a critical role in TNS inhibition of overactive bladder reflexes but are not involved in inhibition of normal bladder reflexes. neuromodulation; brain stem; opioid; tibial; cat TIBIAL NEUROMODULATION, a Food and Drug Administration (FDA)-approved therapy for overactive bladder (OAB) symptoms, including urgency, frequency, and incontinence (7,19,20,29), is often used to treat patients whose symptoms are not completely controlled by drugs or who have unacceptable drug side effects (1,2,8,18). However, the mechanisms underlying tibial neuromodulation therapy are uncertain. Understanding the site of action and neurotransmitters involved in the inhibition of bladder reflexes by tibial nerve stimulation (TNS) is important for developing new OAB treatments by combining drug therapies with tibial neuromodulation to achieve a higher efficacy with fewer side effects (14,33).Previous studies in cats have demonstrated the inhibitory effect of TNS on bladder reflexes elicited during non-nociceptive saline distention as well as nociceptive acetic acid (AA) irritation (23,27). The failure of TNS to inhibit reflex bladder contractions during AA irritation in animals with acute spinal cord transection at the T9/T10 level (32) indicates that supraspinal neural circuits are necessary for TNS inhibition. However, it is unknown whether these supraspinal circuits are located in the forebrain or in the brain stem.A major clinical benefit of TNS is the long-lasting poststimulation inhibitory effect, which allows...

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“…The posterior tibial nerve shares nerve roots with the innervation of the lower urinary tract. It is assumed that there is cross-signaling between sympathetic and parasympathetic nerve terminals and synapses (3,4) .…”

Section: Methodsmentioning

confidence: 99%

“…Following the graduated scheme, if percutaneous posterior tibial nerve stimulation and medications are unsuccessful, onabotulinum toxin A injections can be administered. In desperate cases, augmentation cystoplasty or even cystectomy can be indicated (2,3) . Figure 1: Graduated, stepwise scheme for overactive bladder syndrome treatment [2,3] …”

Section: Introductionmentioning

confidence: 99%

Successful Therapy of Overactive Bladder Syndrome with Percutaneous Tibial Nerve Stimulation: A Case Report

Keller¹,

Schmid²,

Haemmerle³

2017

IAM

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Introduction: Overactive bladder syndrome is defined as urgency with or without incontinence, often with frequency and nocturia but without infection or other pathology. For the patient, overactive bladder syndrome means an essential loss of quality of life. The therapeutic concept follows a graduated, stepwise scheme. The first step consists of behavioral treatment with bladder training and pelvic floor education as well as local estrogen therapy. Following inadequate response to these measures, it is often necessary to add anti-muscarinic drugs or beta-3 agonists. In case of medical contraindication or insufficient response to pharmacologic treatment, neuromodulation, i.e. percutaneous posterior tibial nerve stimulation, should be routinely offered to overactive bladder syndrome patients. Case Report: We present the case of an 81-year-old woman with long-lasting overactive bladder syndrome without incontinence. Behavioural treatment, local estrogen and anti-muscarinic therapy were unsatisfactory, therefore, an additional treatment employing percutaneous posterior tibial nerve stimulation was implemented. Under this regimen, the symptoms dramatically improved. Conclusion: The reported overall success rate of percutaneous posterior tibial nerve stimulation in the literature ranges from 33 -71%, with success being defined as more than a 50% decrease in urgency and a 25% reduction of frequency and nocturia, respectively. There is no other therapeutic option for overactive bladder syndrome patients, that reaches similar success rates. Percutaneous posterior tibial nerve stimulation should be routinely offered to overactive bladder syndrome patients and employed as an early step in the treatment of overactive bladder syndrome, sometimes in combination with or even before the introduction of medications.

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Percutaneous Tibial Nerve Stimulation for the Long-Term Treatment of Overactive Bladder: 3-Year Results of the STEP Study

Abstract: Most STEP participants with an initial positive response to 12 weekly percutaneous tibial nerve stimulation treatments safely sustained overactive bladder symptom improvement to 3 years with an average of 1 treatment per month.

Cited by 173 publications

References 25 publications

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Role of the brain stem in tibial inhibition of the micturition reflex in cats

Successful Therapy of Overactive Bladder Syndrome with Percutaneous Tibial Nerve Stimulation: A Case Report

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