Skip to main content
Top
Published in: Current Urology Reports 5/2012

Open Access 01-10-2012 | Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Percutaneous Tibial Nerve Stimulation: A Clinically and Cost Effective Addition to the Overactive Bladder Algorithm of Care

Authors: David R. Staskin, Kenneth M. Peters, Scott MacDiarmid, Neal Shore, William C. de Groat

Published in: Current Urology Reports | Issue 5/2012

Login to get access

Abstract

Overactive bladder affects millions of adults, with profound personal and economic costs. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest, and many patients are intolerant of the side effects, or do not experience sufficient relief. For these patients, the modulation of bladder reflex pathways via percutaneous tibial nerve stimulation (PTNS) or via implanted sacral nerve stimulation (SNS) has been acknowledged as a logical next step in the algorithm of care. This review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.
Literature
1.
go back to reference •• Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline. 2012. The AUA/SUFU Guidelines for treatment and diagnosis of OAB present a thorough and definitive approach to the patient with OAB, including behavioral interventions, antimuscarinic drugs, and neuromodulation with PTNS and SNS. •• Gormley EA, Lightner DJ, Burgio KL, Chai TC, Clemens JQ, Culkin DJ, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline. 2012. The AUA/SUFU Guidelines for treatment and diagnosis of OAB present a thorough and definitive approach to the patient with OAB, including behavioral interventions, antimuscarinic drugs, and neuromodulation with PTNS and SNS.
2.
go back to reference Finazzi-Agro E, Petta F, Sciobica F, Pasqualetti P, Musco S, Bove P. Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. J Urol. 2010;184(5):2001–6. doi:10.1016/j.juro.2010.06.113.PubMedCrossRef Finazzi-Agro E, Petta F, Sciobica F, Pasqualetti P, Musco S, Bove P. Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. J Urol. 2010;184(5):2001–6. doi:10.​1016/​j.​juro.​2010.​06.​113.PubMedCrossRef
3.
go back to reference Govier FE, Litwiller S, Nitti V, Kreder Jr KJ, Rosenblatt P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165(4):1193–8.PubMedCrossRef Govier FE, Litwiller S, Nitti V, Kreder Jr KJ, Rosenblatt P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165(4):1193–8.PubMedCrossRef
4.
go back to reference •• MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC, et al. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol. 2010;183(1):234–40. doi:10.1016/j.juro.2009.08.160. This is the 12 month follow-on study to the OrBIT study comparing UPC and tolterodine, originally published by study Peters KM, MacDiarmid SA,Wooldridge L, et al, showing sustained symptom improvement for PTNS responders. PubMedCrossRef •• MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC, et al. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol. 2010;183(1):234–40. doi:10.​1016/​j.​juro.​2009.​08.​160. This is the 12 month follow-on study to the OrBIT study comparing UPC and tolterodine, originally published by study Peters KM, MacDiarmid SA,Wooldridge L, et al, showing sustained symptom improvement for PTNS responders. PubMedCrossRef
5.
go back to reference •• Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438–43. doi:10.1016/j.juro.2009.12.036. This paper presents the data from a randomized, placebo-controlled study of PTNS versus a sham treatment. This paper presents Level 1 evidence of effectiveness of PTNS. PubMedCrossRef •• Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438–43. doi:10.​1016/​j.​juro.​2009.​12.​036. This paper presents the data from a randomized, placebo-controlled study of PTNS versus a sham treatment. This paper presents Level 1 evidence of effectiveness of PTNS. PubMedCrossRef
6.
go back to reference •• Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055–61. doi:10.1016/j.juro.2009.05.045. This is one of the randomized, controlled studies of PTNS, and demonstrates comparable response rates of patients treated with PTNS versus tolterodine. PubMedCrossRef •• Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055–61. doi:10.​1016/​j.​juro.​2009.​05.​045. This is one of the randomized, controlled studies of PTNS, and demonstrates comparable response rates of patients treated with PTNS versus tolterodine. PubMedCrossRef
7.
go back to reference •• Vandoninck V, van Balken MR, Finazzi Agro E, Petta F, Micali F, Heesakkers JP, et al. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32. doi:10.1002/nau.10111. This paper provides urodynamic data on patients treated with PTNS, and supplements the subjective data (frequency, urgency, bother) presented in the randomized, controlled studies of PTNS. PubMedCrossRef •• Vandoninck V, van Balken MR, Finazzi Agro E, Petta F, Micali F, Heesakkers JP, et al. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32. doi:10.​1002/​nau.​10111. This paper provides urodynamic data on patients treated with PTNS, and supplements the subjective data (frequency, urgency, bother) presented in the randomized, controlled studies of PTNS. PubMedCrossRef
9.
go back to reference Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36. doi:10.1007/s00345-002-0301-4.PubMed Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–36. doi:10.​1007/​s00345-002-0301-4.PubMed
10.
go back to reference Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(5 Suppl 2):28–37. discussion 40-2.PubMedCrossRef Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(5 Suppl 2):28–37. discussion 40-2.PubMedCrossRef
13.
go back to reference Brown JS, McGhan WF, Chokroverty S. Comorbidities associated with overactive bladder. Am J Manage Care. 2000;6:S574–9. Brown JS, McGhan WF, Chokroverty S. Comorbidities associated with overactive bladder. Am J Manage Care. 2000;6:S574–9.
14.
go back to reference Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population based prevalence study. BJU Int. 2001;87:760–6.PubMedCrossRef Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population based prevalence study. BJU Int. 2001;87:760–6.PubMedCrossRef
15.
go back to reference McPherson A. The effects of somatic stimuli on the bladder in the cat. J Physiol. 1966;185(1):185–96.PubMed McPherson A. The effects of somatic stimuli on the bladder in the cat. J Physiol. 1966;185(1):185–96.PubMed
16.
go back to reference McPherson A. Vesico-somatic reflexes in the chronic spinal cat. J Physiol. 1966;185(1):197–204.PubMed McPherson A. Vesico-somatic reflexes in the chronic spinal cat. J Physiol. 1966;185(1):197–204.PubMed
17.
go back to reference Sato A, Sato Y, Schmidt RF, Torigata Y. Somato-vesical reflexes in chronic spinal cats. J Auton Nerv Syst. 1983;7:351–62.PubMedCrossRef Sato A, Sato Y, Schmidt RF, Torigata Y. Somato-vesical reflexes in chronic spinal cats. J Auton Nerv Syst. 1983;7:351–62.PubMedCrossRef
18.
go back to reference McGuire E, Morrissey S, Zhang S, Horwinski E. Control of reflex detrusor activity in normal and spinal injured non-human primates. J Urol. 1983;129(1):197–9.PubMed McGuire E, Morrissey S, Zhang S, Horwinski E. Control of reflex detrusor activity in normal and spinal injured non-human primates. J Urol. 1983;129(1):197–9.PubMed
19.
go back to reference McGuire EJ, Zhang SC, Horwinski ER, Lytton B. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol. 1983;129(1):78–9.PubMed McGuire EJ, Zhang SC, Horwinski ER, Lytton B. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol. 1983;129(1):78–9.PubMed
20.
go back to reference Tai C, Shen B, Chen M, Wang J, Roppolo JR, de Groat WC. Prolonged poststimulation inhibition of bladder activity induced by tibial nerve stimulation in cats. Am J Physiol Ren Physiol. 2011;300(2):F385–92. doi:10.1152/ajprenal.00526.2010.CrossRef Tai C, Shen B, Chen M, Wang J, Roppolo JR, de Groat WC. Prolonged poststimulation inhibition of bladder activity induced by tibial nerve stimulation in cats. Am J Physiol Ren Physiol. 2011;300(2):F385–92. doi:10.​1152/​ajprenal.​00526.​2010.CrossRef
21.
22.
go back to reference Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56(5):766–71.PubMedCrossRef Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56(5):766–71.PubMedCrossRef
23.
go back to reference Vandoninck V, van Balken MR, Finazzi Agro E, Heesakkers JP, Debruyne FM, Kiemeney LA, et al. Posterior tibial nerve stimulation in the treatment of voiding dysfunction: urodynamic data. Neurourol Urodyn. 2004;23(3):246–51. doi:10.1002/nau.10158.PubMedCrossRef Vandoninck V, van Balken MR, Finazzi Agro E, Heesakkers JP, Debruyne FM, Kiemeney LA, et al. Posterior tibial nerve stimulation in the treatment of voiding dysfunction: urodynamic data. Neurourol Urodyn. 2004;23(3):246–51. doi:10.​1002/​nau.​10158.PubMedCrossRef
25.
go back to reference Payne CK, Kelleher C. Redefining response in overactive bladder syndrome. BJU Int. 2007;99:101–6.PubMedCrossRef Payne CK, Kelleher C. Redefining response in overactive bladder syndrome. BJU Int. 2007;99:101–6.PubMedCrossRef
26.
go back to reference •• Peters KM, Carrico DJ, Macdiarmid SA, Wooldridge LS, Khan AU, McCoy CE et al. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. LID - doi: 10.1002/nau.22266. (1520-6777 (Electronic)). This is the 24 month follow-on study to the SUmiTstudy, originally published by Peters KM, Carrico DJ, Perez-Marrero RA, et al, showing 24 month sustained symptom improvement for PTNS responders. •• Peters KM, Carrico DJ, Macdiarmid SA, Wooldridge LS, Khan AU, McCoy CE et al. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. LID - doi: 10.​1002/​nau.​22266. (1520-6777 (Electronic)). This is the 24 month follow-on study to the SUmiTstudy, originally published by Peters KM, Carrico DJ, Perez-Marrero RA, et al, showing 24 month sustained symptom improvement for PTNS responders.
27.
go back to reference • Chapple C, Khullar V, Gabriel Z, Dooley JA. The effects of antimuscarinic treatments in overactive bladder: a systematic review and meta-analysis. Eur Urol. 2005;48(1):5–26. doi:10.1016/j.eururo.2005.02.024. This is a systematic review of the antimuscarinic drugs that have been tested for efficacy in OAB, and provides head-to-head comparison in outcome measures as well as side effects. This is the latest in a series of systematic reviews, and builds upon reviews done in 2003 and 2005 by the same authors. PubMedCrossRef • Chapple C, Khullar V, Gabriel Z, Dooley JA. The effects of antimuscarinic treatments in overactive bladder: a systematic review and meta-analysis. Eur Urol. 2005;48(1):5–26. doi:10.​1016/​j.​eururo.​2005.​02.​024. This is a systematic review of the antimuscarinic drugs that have been tested for efficacy in OAB, and provides head-to-head comparison in outcome measures as well as side effects. This is the latest in a series of systematic reviews, and builds upon reviews done in 2003 and 2005 by the same authors. PubMedCrossRef
28.
go back to reference Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: A systematic review and meta-analysis. LID - doi: 10.1002/nau.22251. (1520-6777 (Electronic)). Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: A systematic review and meta-analysis. LID - doi: 10.​1002/​nau.​22251. (1520-6777 (Electronic)).
29.
go back to reference Shamliyan T, Wyman J, Kane RL. Nonsurgical treatments for urinary incontinence in adult women: Diagnosis and comparative effectiveness. Rockville, MD: Agency for Healthcare Research and Quality2012. Report No.: AHRQ Publication No. 11(12)-EHC074-EF. Shamliyan T, Wyman J, Kane RL. Nonsurgical treatments for urinary incontinence in adult women: Diagnosis and comparative effectiveness. Rockville, MD: Agency for Healthcare Research and Quality2012. Report No.: AHRQ Publication No. 11(12)-EHC074-EF.
31.
go back to reference Schmidt RA, Jonas U, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. J Urol. 1999;162:352–7.PubMedCrossRef Schmidt RA, Jonas U, Oleson KA, Janknegt RA, Hassouna MM, Siegel SW, et al. Sacral nerve stimulation for treatment of refractory urinary urge incontinence. J Urol. 1999;162:352–7.PubMedCrossRef
33.
go back to reference Yalcin I, Bump RC. Validation of two global impression questionaires for incontinence. Am J Obstet Gynecol. 2003;189:98–100.PubMedCrossRef Yalcin I, Bump RC. Validation of two global impression questionaires for incontinence. Am J Obstet Gynecol. 2003;189:98–100.PubMedCrossRef
34.
go back to reference • Peters KM, Killinger KA, Ibrahim AM, Villaba PS. The relationship between subjective and objective assessments of sacral neuromodulation effectiveness in patients with urgency-frequency. Neurourol Urodyn. 2008;27:775–8. This paper reviews the value of the subjective measurements (urgency, frequency, bother) that underpin evaluation of the effectiveness of treatments for OAB. Since OAB is largely a disease of symptoms, subjective measures are critical to the evaluation of effectiveness; fortunately, subjective measurements typically follow objective measurements. PubMedCrossRef • Peters KM, Killinger KA, Ibrahim AM, Villaba PS. The relationship between subjective and objective assessments of sacral neuromodulation effectiveness in patients with urgency-frequency. Neurourol Urodyn. 2008;27:775–8. This paper reviews the value of the subjective measurements (urgency, frequency, bother) that underpin evaluation of the effectiveness of treatments for OAB. Since OAB is largely a disease of symptoms, subjective measures are critical to the evaluation of effectiveness; fortunately, subjective measurements typically follow objective measurements. PubMedCrossRef
36.
go back to reference • Gopal M, Haynes K, Bellamy SL, Arya LA. Discontinuation rates of anticholinergic medications used for the treatment of lower urinary tract symptoms. Obstet Gynecol. 2008;112(6):1311–8. doi:10.1097/AOG.0b013e31818e8aa4. This paper shows the discouraging rate of discontinuance of anticholinergic medications used for OAB. Although pharmacologic studies uniformly demonstrate efficacy, in the real world patients either do not receive sufficient benefit, or the side effects are intolerable for the patients to continue. Most patients get only a few months benefit from drug therapy before they discontinue taking the medications. PubMedCrossRef • Gopal M, Haynes K, Bellamy SL, Arya LA. Discontinuation rates of anticholinergic medications used for the treatment of lower urinary tract symptoms. Obstet Gynecol. 2008;112(6):1311–8. doi:10.​1097/​AOG.​0b013e31818e8aa4​. This paper shows the discouraging rate of discontinuance of anticholinergic medications used for OAB. Although pharmacologic studies uniformly demonstrate efficacy, in the real world patients either do not receive sufficient benefit, or the side effects are intolerable for the patients to continue. Most patients get only a few months benefit from drug therapy before they discontinue taking the medications. PubMedCrossRef
37.
go back to reference Hartmann KE, McPheeters ML, Biller DH, Ward RM, McKoy JN, Jerome RN, et al. Treatment of overactive bladder in women. Evid Rep Technol Assess (Full Rep). 2009; Suppl 187:1-120, v. Hartmann KE, McPheeters ML, Biller DH, Ward RM, McKoy JN, Jerome RN, et al. Treatment of overactive bladder in women. Evid Rep Technol Assess (Full Rep). 2009; Suppl 187:1-120, v.
40.
go back to reference Woodbridge LS. Percutaneous tibial nerve stimulation for the treatment of urinary frequency, urgency, and urge incontinence: results from a community based clinic. Urol Nurs. 2009;29:177–85. Woodbridge LS. Percutaneous tibial nerve stimulation for the treatment of urinary frequency, urgency, and urge incontinence: results from a community based clinic. Urol Nurs. 2009;29:177–85.
Metadata
Title
Percutaneous Tibial Nerve Stimulation: A Clinically and Cost Effective Addition to the Overactive Bladder Algorithm of Care
Authors
David R. Staskin
Kenneth M. Peters
Scott MacDiarmid
Neal Shore
William C. de Groat
Publication date
01-10-2012
Publisher
Current Science Inc.
Published in
Current Urology Reports / Issue 5/2012
Print ISSN: 1527-2737
Electronic ISSN: 1534-6285
DOI
https://doi.org/10.1007/s11934-012-0274-9

Other articles of this Issue 5/2012

Current Urology Reports 5/2012 Go to the issue

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

The Incidence and Etiology of Overactive Bladder in Patients After Cerebrovascular Accident

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

The Treatment of Lower Urinary Tract Symptoms in Patients With Multiple Sclerosis: A Systematic Review

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Interstitial Cystitis and the Overlap With Overactive Bladder

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

How Do Urodynamics Findings Influence the Treatment of the Typical Patient With Overactive Bladder?

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

The Role of Neuromodulation in Patients with Neurogenic Overactive Bladder

Voiding Dysfunction and Lower Urinary Tract Symptoms (GH Badlani and HB Goldman, Section Editors)

Bladder Augmentation and Urinary Diversion for Neurogenic LUTS: Current Indications