Posterior tibial nerve stimulation in patients with intractable interstitial cystitis

Abstract

OBJECTIVE To evaluate the efficacy of intermittent percutaneous posterior tibial nerve stimulation (PPTNS) in patients with refractory interstitial cystitis. PATIENTS AND METHODS One man and 13 women (mean age 58.3 years) with suprapubic or perineal pain were enrolled in a prospective open study, in which they had 10 weekly sessions of PPTNS. Their mean duration of symptoms was 8.3 years. All patients were previously diagnosed as having interstitial cystitis according to the National Institute of Diabetes and Digestive and Kidney Diseases criteria. The response to the treatment were assessed using voiding diary, visual analogue scale diary for a pain index, and the Interstitial Cystitis Problem Index (ICPI), O’Leary/Sant Interstitial Cystitis Symptom Index (ICSI) and the 36‐item short‐form health survey (SF‐36) quality‐of‐life questionnaire. RESULTS Of the 14 patients, 13 completed the 10 weeks of treatment with no complications; 12 continued treatment for a short period after the study. There were no statistically significant changes in pain scores, voiding frequency and volumes, or in the ICPI, ICSI and SF‐36 scores. However, there was an improvement in some patients, with one having complete resolution of the pain. CONCLUSION Intermittent PPTNS in patients with refractory interstitial cystitis has no significant clinical effect over 10 weeks of treatment.

Qualidade de vida de mulheres com bexiga hiperativa refratária tratadas com estimulação elétrica do nervo tibial posterior

“…PTNS was applied during 12 sessions, twice a week. The choice of this frequency was based on several studies in which the beneficial effects of neuromodulation triggered by PTNS were observed after a median treatment of 12 sessions, once or twice weekly 4,10,11,14,15,[18][19][20][21][22][23][24][25] . We chose to apply the sessions twice a week because this frequency is said to intensify the effects of PTNS in neuronal plasticity.…”

“…A plastic cylinder, about 3 mm shorter than the needle was used to aid the insertion of the needle, which remained inserted approximately 3 to 4 cm posterior to the tibia after perforation of the skin and removal of the plastic cylinder. The needles were inserted in both legs at the same point, and with the same methodology 4,10,11,14,15,[18][19][20][21][22][23][24][25] . A self-adhesive reference electrode was positioned close to the medial malleolus, near the heel, closing the circuit for the electrical stimulation, as shown in Figure 2.…”

“…These are the most likely areas in which the therapeutic effect of neuromodulation of the bladder by PTNS acts, and this 30-minute stimulus already has a beneficial effect 16,17 . Authors who have studied the effects of PTNS consider it a good therapeutic option for the treatment of OAB because of its low cost and the lack of the side effects of drug therapy 4,10,11,14,15,[18][19][20][21][22][23][24] . In comparison with other electrical stimulation techniques, it has the advantage of generating less discomfort and embarrassment to patients because it is not applied to the genital area 4,10,[22][23][24] .…”

“…Some cite the use of such electrical stimulation in children with neurogenic bladder, non-neurogenic urinary retention and uncoordinated voiding 18,21 , and others relate their experience with adult men and women with neurogenic OAB by multiple sclerosis, Parkinson's disease, cord injury and idiopathic OAB 11,14,15,19 . However, a limitation of most of these studies is the study of mixed populations that include male and female patients 4,10,14,15,[20][21][22][23][24][25] with neurogenic and idiopathic OAB 4,14,15,20,25 , for example. In these studies, the authors use as methods of evaluation both urodynamic and quality of life (QoL) parameters 4 .…”

Urodynamic Effect of Percutaneous Posterior Tibial Nerve Stimulation for Urinary Incontinence in Paraparetic Patients

“…Fjorback et al [38] also reported that PTNS showed no effect or failed to suppress detrusor contraction in patients with neurological detrusal overactivity, but there was an increase in the cyctometric bladder capacity and bladder volume during the first contraction after PTNS application.…”