Do Failure of Posterior Tibial Nerve Stimulation Precludes to Use Sacral Neuromodulation in Patient With Overactive Bladder?

Abstract

To evaluate the outcomes of sacral neuromodulation (SNM) after failure of transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with overactive bladder (OAB). Methods: A retrospective study was conducted in 3 university hospitals and included all patients with OAB and treated with SNM after TPTNS had been tried between October 2008 and May 2018. The primary endpoint was the proportion of definitive SNM device implantation in patients with 50% objective and/or subjective improvement after a test period (stage 1). The secondary outcomes of interest were changes of the number of diurnal voids and nocturia episodes per 24 hours between the end of TPTNS and the end of stage 1. Results: Overall, 28 of the 43 patients included achieved at least 50% objective and/or subjective improvement during stage 1 and underwent an Interstim II implantation (65.1%). The mean daytime frequency decreased significantly from 10.3/day at the end of TPTNS to 7.8 diurnal voids/day at the end of SNM stage 1 (P = 0.01). The mean number of nocturia episodes decreased from 2.5/night at the end of TPTNS to 2.1/night at the end of stage 1, but this did not reach statistical significance (P = 0.18). There was no other parameter significantly associated with response to SNM Conclusions: SNM might improve OAB symptoms in most patients who experienced no or poor efficacy with TPTNS. History of failed TPTNS should not preclude the use of SNM in OAB patients.

Response to tibial and sacral nerve modulation in overactive bladder: Is there any correlation?

“…Although previous retrospective studies have partially explored this question, they were limited by a small number of patients, all of whom had previously failed TTNS. 12,13 Thus, the predictive value of the response to TTNS on the subsequent response to SNM could not be determined. To our knowledge, this study is the first to comprehensively investigate whether the response to TTNS (success or failure) can predict the response to SNM in the treatment of OAB.…”

“…Although previous retrospective studies have partially explored this question, they were limited by a small number of patients, all of whom had previously failed TTNS 12,13 . Thus, the predictive value of the response to TTNS on the subsequent response to SNM could not be determined.…”

“…To note, all nonresponders reported "no change," except one who reported to be "a little worse." Regarding the four patients who previously received intravesical injections of botulinum toxinA, the median wash-out period since the last injection was 14 months [13][14][15][16][17][18][19][20][21][22]. Similarly, all medications for OAB were supposed to be discontinued before TTNS initiation.…”

Novel botulinum neurotoxin-A tibial nerve perineural injection to alleviate overactive bladder symptoms in male rats

“…Another important concern regarding the novel injection site is the potential adverse effects on the local musculature, particularly temporal paralysis, caused by passive diffusion of the agent (Peters et al 2010 ; Staskin et al 2012 ; Berthelot et al 2019 ). The kinetic function of the rats of the treatment group appeared normal.…”

“…Sacral neuromodulation, once hailed as the quintessential treatment method for OAB as it taps directly into the theoretical neurogenic pathophysiology, is unreliable, prone to malfunction, and difficult to apply. Consequently, its practice is limited to only a select few tertiary centres (Birder and De Groat 2007 ; Castro-Diaz et al 2014 ; Berthelot et al 2019 ; Hernández-Hernández et al 2021 ). A recent evolution of this line of treatment, percutaneous tibial nerve stimulation (PTNS), allows easier access to the nervous system through the peripheral route (Peters et al 2010 ; Staskin et al 2012 ; de Wall and Heesakkers 2017 ; Zeng et al 2020 ; Girtner et al 2021 ; Li et al 2021 ).…”