Neuromodulative treatment with percutaneous tibial nerve stimulation for intractable detrusor instability:outcomes following a shortened 6-week protocol.

By:

Yoong, W

Contributor(s):

Publication details: 2010ISSN:

14644096

Uniform titles:

BJU international.

Online resources:

Summary: OBJECTIVE: To describe our initial outcome data following a shortened 6-week treatment protocol with percutaneous tibialnerve stimulation (PTNS) in women with overactive bladder syndrome (OABS) unresponsive to bladder retraining and anticholinergic therapy.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">PATIENTS AND METHODS:</h4>This was a prospective observational study over a 6-month period. In all, 43 women with OABS refractory to medical therapy were treated with a shortened PTNS protocol that consisted of 6 weekly 30 min sessions. Bladder symptom diaries and health-related quality of life (HRQL) assessed using the short-form seven-item self-report. Incontinence Impact Questionnaire (IIQ-7) were completed before and after treatment. A positive response was defined as: (i) OAB symptoms no longer being bothersome; (ii) reduction by half in frequency episodes and (iii) reduction by 25% in IIQ-7outcomes.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">RESULTS:</h4>All 43 women (median age 55.3 years) completed six treatments with a positive response rate of 69.7%. In the positive responders, the median daytime and nocturnal frequency was reduced by half after 6 weeks of treatment (11.8 vs 6.9 and 3.5 vs 1.8, respectively, P < 0.05) and the patients reported fewer urge leak episodes per 24 h (median 3.5 vs 2.4, P < 0.05). The median IIQ-7 scores improved by 25% (30.4 vs 24.3, P < 0.05) in responders, while the median number of pads changed in 24 h also decreased by 34% (3.8 vs 2.5, P < 0.05). The median acceptability of the technique when scored by Visual Analogue Score was 9.6/10 and no side-effects were reported.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">CONCLUSION:</h4>A shortened 6-week treatment with PTNS appears to be successful, with a significant reduction in symptoms and improvement in HRQL. This early data suggest that the duration of treatment for peripheral neuromodulation can be halved compared with the conventional 12 weeks, which would make it more acceptable and cost effective for patients. A randomised controlled trial of 6 weeks vs 12 weeks of PTNS therapy would be useful in determining the optimal duration of treatment

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Item type	Home library	Collection	Class number	Status	Date due	Barcode
UNKNOWN	Ferriman Information and Library Service (North Middlesex) Online	Staff publications for NMDX		Available

NMUH Staff Publications

Available in print at Ferriman Library

106

OBJECTIVE: To describe our initial outcome data&nbsp;following&nbsp;a&nbsp;shortened&nbsp;6-week&nbsp;treatment&nbsp;protocol&nbsp;with&nbsp;percutaneous&nbsp;tibialnerve&nbsp;stimulation&nbsp;(PTNS) in women with overactive bladder syndrome (OABS) unresponsive to bladder retraining and anticholinergic therapy.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">PATIENTS AND METHODS:</h4>This was a prospective observational study over a 6-month period. In all, 43 women with OABS refractory to medical therapy were treated with a&nbsp;shortened&nbsp;PTNS&nbsp;protocol&nbsp;that consisted of 6 weekly 30 min sessions. Bladder symptom diaries and health-related quality of life (HRQL) assessed using the short-form seven-item self-report. Incontinence Impact Questionnaire (IIQ-7) were completed before and after&nbsp;treatment. A positive response was defined as: (i) OAB symptoms no longer being bothersome; (ii) reduction by half in frequency episodes and (iii) reduction by 25% in IIQ-7outcomes.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">RESULTS:</h4>All 43 women (median age 55.3 years) completed six treatments with a positive response rate of 69.7%. In the positive responders, the median daytime and nocturnal frequency was reduced by half after 6 weeks of&nbsp;treatment&nbsp;(11.8 vs 6.9 and 3.5 vs 1.8, respectively, P &lt; 0.05) and the patients reported fewer urge leak episodes per 24 h (median 3.5 vs 2.4, P &lt; 0.05). The median IIQ-7 scores improved by 25% (30.4 vs 24.3, P &lt; 0.05) in responders, while the median number of pads changed in 24 h also decreased by 34% (3.8 vs 2.5, P &lt; 0.05). The median acceptability of the technique when scored by Visual Analogue Score was 9.6/10 and no side-effects were reported.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">CONCLUSION:</h4>A&nbsp;shortened&nbsp;6-week&nbsp;treatment&nbsp;with PTNS appears to be successful, with a significant reduction in symptoms and improvement in HRQL. This early data suggest that the duration of&nbsp;treatment&nbsp;for peripheral neuromodulation can be halved compared with the conventional 12 weeks, which would make it more acceptable and cost effective for patients. A randomised controlled trial of 6 weeks vs 12 weeks of PTNS therapy would be useful in determining the optimal duration of&nbsp;treatment

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