Posterior tibial nerve stimulation in the treatment of urge incontinence

Vandoninck, Vera; Balken, Michael R. van; Agrò, Enrico Finazzi; Petta, Filomena; Caltagirone, Carlo; Heesakkers, John; Kiemeney, Lambertus A.; Debruyne, F.M.J.; Bemelmans, Bart L.H.

doi:10.1002/nau.10036

Cited by 147 publications

(119 citation statements)

References 36 publications

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“…Reports on clinical outcome were published recently. [3][4][5][6] As part of this study sexual functioning has been evaluated as well as possible effects of PTNS on sexual impairment.…”

Section: Methodsmentioning

confidence: 99%

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

2006

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In this study, we evaluated the effect of lower urinary tract dysfunction and its neuromodulative therapy on sexual functioning. We studied 121 patients with an overactive bladder (OAB) (N ¼ 83), chronic pelvic pain (N ¼ 23) and nonobstructive retention (N ¼ 15), which were treated with neuromodulation (i.e. percutaneous tibial nerve stimulation, PTNS). To obtain information on their sexual function, a self-administered standardized questionnaire was filled out before therapy as well as after 12 weeks of treatment. Before therapy, different aspects of sexual life were considered not normal in 25.3-45.6% of the cases. This improved significantly after treatment. Patients most likely to benefit were women, patients with an OAB and subjective responders. The aspects of sexual life which mostly improved were overall satisfaction, libido and the frequency of sexual activities. Sexual dysfunction is observed in a lot of patients with lower urinary tract disorders and may improve on successful therapy for the latter.

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“…Reports on clinical outcome were published recently. [3][4][5][6] As part of this study sexual functioning has been evaluated as well as possible effects of PTNS on sexual impairment.…”

Section: Methodsmentioning

confidence: 99%

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

2006

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“…[123][124][125] The necessity to diagnose DO on UDS and its role in improving patient-related outcome measures needs to be evaluated in future diagnostic RCTs.…”

Section: Recommendations For Researchmentioning

confidence: 99%

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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“…Tibial-nerve stimulation delivers neuromodulation to the pelvic floor through the S2-S4 junction of the sacral nerve plexus via the less invasive route of the posterior tibial nerve. This anatomical area has projections to the sacral nerve plexus, creating a feed-back loop that modulates bladder innervations (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Electrical Stimulation for Urinary Incontinence in Women: A Systematic Review

et al. 2013

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Background: Electrical stimulation is commonly recommended to treat urinary incontinence in women. It includes several techniques that can be used to improve stress, urge, and mixed symptoms. However, the magnitude of the alleged benefits is not completely established. Objectives: To determine the effects of electrical stimulation in women with symptoms or urodynamic diagnoses of stress, urge, and mixed incontinence. Search Strategy: Our review included articles published between January 1980 and January 2012. We used the search terms "urinary incontinence", "electrical stimulation", "intravaginal", "tibial nerve" and "neuromodulation" for studies including female patients. Selection Criteria: We evaluated randomized trials that included electrical stimulation in at least one arm of the trial, to treat women with urinary incontinence. Data Collection and Analysis: Two reviewers independently assessed the data from the trials, for inclusion or exclusion, and methodological analysis. Main Results: A total of 30 randomized clinical trials were included. Most of the trials involved intravaginal electrical stimulation. Intravaginal electrical stimulation showed effectiveness in treating urge urinary incontinence, but reported contradictory data regarding stress and mixed incontinence. Tibial-nerve stimulation showed promising results in randomized trials with a short follow-up period. Sacral-nerve stimulation yielded interesting results in refractory patients. Conclusions: Tibial-nerve and intravaginal stimulation have shown effectiveness in treating urge urinary incontinence. Sacral-nerve stimulation provided benefits in refractory cases. Presently available data provide no support for the use of intravaginal electrical stimulation to treat stress urinary incontinence in women. Further randomized trials are necessary to determine the magnitude of benefits, with long-term follow-up, and the effectiveness of other electrical-stimulation therapies.

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Posterior tibial nerve stimulation in the treatment of urge incontinence

Abstract: We conclude that posterior tibial nerve stimulation is an effective, minimally invasive option for treatment of patients with complaints of urge incontinence, as improvement was seen in subjective as well as objective parameters.

Cited by 147 publications

References 36 publications

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

Sexual functioning in patients with lower urinary tract dysfunction improves after percutaneous tibial nerve stimulation

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Electrical Stimulation for Urinary Incontinence in Women: A Systematic Review

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