Factors Associated With Long-Term Use of Percutaneous Tibial Nerve Stimulation for Management of Overactive Bladder Syndrome

Abstract

Objectives The aims of the study were to estimate the rate of percutaneous tibial nerve stimulation maintenance therapy (PTNS-MT) among women with overactive bladder syndrome (OAB) and evaluate factors associated with long-term use of PTNS. Methods Patients who completed 12 weekly sessions of PTNS (PTNS-IN) for OAB between 2009 and 2016 within the Kaiser Permanente Northern California were identified using Current Procedural Terminology and International Classification of Diseases codes. Bivariate analysis was performed to compare demographic and clinical variables. A logistic regression model was used to determine factors associated with PTNS-MT compared with the use of alternative treatments following PTNS-IN. Results Of the 1331 patients who initiated PTNS for OAB, 347 (26%) completed PTNS-IN. Of these, 46% (n = 158) continued with long-term PTNS therapy, defined as completion of at least 8 additional PTNS sessions for a 32-week period. On bivariate analysis, those choosing PTNS-MT were more likely to be white (88%, P < 0.0001), nondiabetic (89%, P = 0.03), did not use anticholinergics before PTNS initiation (41%, P = 0.04), and had no prior surgery for stress incontinence (SUI; 84%, P = 0.01). In multivariable analysis, race was a significant factor with black, Hispanic, and Asian women less likely to continue with PTNS-MT. Women with prior use of first-line OAB therapy were 78% more likely to undergo PTNS-MT. Women with prior surgery for SUI were 53% less likely to continue PTNS-MT. Conclusions Almost half of patients who completed PTNS-IN continued with PTNS-MT. White race, prior use of first-line OAB therapy, and no prior surgery for SUI were associated with long-term therapy.

Third‐line therapy for overactive bladder in the elderly: Nuances and considerations

“…46 A Northern California claims-based analysis of 1331 patients with a mean age of 69.8 years initiating PTNS for OAB found just 26% completed a 12-week initial course. 51 Interestingly, older age trended as a predictor of continuing therapy: patients completing maintenance were older (68.9 vs. 70.9 years, p = 0.11) and age >85 years trended as a positive predictor (OR 1.98, p = 0.10).…”

“…A retrospective study in over 400 patients treated with PTNS for OAB found just 57% continue after 12‐week initial treatment, with 40% of those stopping maintenance therapy due to logistic reasons and physical strain 46 . A Northern California claims‐based analysis of 1331 patients with a mean age of 69.8 years initiating PTNS for OAB found just 26% completed a 12‐week initial course 51 . Interestingly, older age trended as a predictor of continuing therapy: patients completing maintenance were older (68.9 vs. 70.9 years, p = 0.11) and age >85 years trended as a positive predictor (OR 1.98, p = 0.10).…”

Rationale and design of an implant procedure and pivotal study to evaluate safety and effectiveness of Medtronic's tibial neuromodulation device

“…In a prospective study that had high adherence to therapy sessions, UUI responder rates have been shown to be as high as 78% after 12 sessions[ 11 ]. However, the available data suggest that outside of prospective clinical studies, real-world therapy adherence to the first 12 sessions varies and may be as low as 26%[ 12 ].…”

Race in Clinical Algorithms and Calculators in Urogynecology: What Is Glaring to Us

“…Using the calculator in clinical practice could counsel women from minoritized racial groups away from Botox use. Studies have shown that women from historically marginalized racial groups are less likely to seek treatment for OAB and less likely to use third-line treatments for OAB 10,11 . The lower predicted success rate for patients who are not White may lead clinicians to recommend a different treatment option, a phenomenon that we have already seen in obstetrics with the use of race in the original vaginal birth after cesarean calculators 12 …”

“…Studies have shown that women from historically marginalized racial groups are less likely to seek treatment for OAB and less likely to use third-line treatments for OAB. 10,11 The lower predicted success rate for patients who are not White may lead clinicians to recommend a different treatment option, a phenomenon that we have already seen in obstetrics with the use of race in the original vaginal birth after cesarean calculators. 12 Including race as a stand-alone variable in calculators assumes that race represents a well-defined variable such as age or education level, which is not the case.…”