Tibial Nerve Stimulation Works for Long-Term Treatment of Overactive Bladder


Symptoms of overactive bladder were reduced in patients who received percutaneous tibial nerve stimulation (PTNS), according to the results of a 3-year study.

Symptoms of overactive bladder were reduced in patients who received percutaneous tibial nerve stimulation (PTNS), according to the results of a 3-year study.1
Previous studies have shown that PTNS is an effective treatment for OAB, but long-term safety and efficacy data were lacking. These new findings show that patients with overactive bladder who do not respond to traditional first-line treatment, usually anticholinergic medications and behavioral therapy, have a safe and effective alternative long-term treatment option.
Of 50 patients who met the primary effectiveness end point after 12 weekly PTNS treatments and who subsequently were enrolled in a prospective study to assess long-term outcomes, 29 patients completed the 36-month protocol. All patients were prescribed a fixed 14-week tapering protocol and then prescribed a personal treatment plan, the goal of which was to sustain improvements in symptoms of overactive bladder.
On average, patients received about 1 treatment per month after the initial 14-week tapering protocol. It was estimated that 77% of participants had moderate or marked improvement in overactive bladder symptoms at 3 years. Specifically, significant improvements in urinary frequency, urgency, and incontinence were noted. Compared with baseline data, the median number of voids per day decreased from 12 to 8.7, the median number of voids per night decreased from 2.7 to 1.7, and the median number of urge incontinence episodes per day decreased from 3.3 to 0.3, all statistically significant reductions (P<0.0001).
During the study, patients completed questionnaires about overactive bladder symptoms and quality of life every 3 months and kept 3-day voiding diaries every 6 months. The study authors reported that all quality-of-life parameters remained markedly improved throughout the 3-year study.
PTNS involves the insertion of a slim needle electrode into the ankle near the tibial nerve. A handheld stimulator emits electric impulses that are carried to the nerves in the spinal cord that control pelvic floor function. It can be performed in an outpatient setting and is generally painless. During the study, the only reported treatment-related adverse event was bleeding at the needle site during follow-up. This occurred on 2 separate occasions in the same patient, indicating that this may have been a patient-specific issue.

Pertinent Points:
- The long-term use of percutaneous tibial nerve stimulation (PTNS) is a safe and effective treatment for certain patients who do not adequately respond to anticholinergic medications and behavioral therapy.
- Patients undergoing PTNS for the 3-year study period had significant improvements in urinary frequency, urgency, and incontinence.


1. Peters KM, Carrico DJ, Wooldridge LS, et al. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189:2194-2201.

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