Percutaneous tibial nerve stimulation in the treatment of overactive bladder: Urodynamic data

Vandoninck, Vera; Balken, Michael R. van; Agrò, Enrico Finazzi; Petta, Filomena; Micali, F; Heesakkers, John; Debruyne, F.M.J.; Kiemeney, Lambertus A.; Bemelmans, Bart L.H.

doi:10.1002/nau.10111

Cited by 111 publications

(84 citation statements)

References 18 publications

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“…[13] More than 30 studies regarding PTNS have been published. The earliest ones are case series or single-arm efficacy studies, [14][15][16] three are randomized, controlled trials, [9,17,18] and two are long-term follow-up studies of patients who were responders in the overactive bladder innovative therapy (OrBIT) and sham effectiveness in the treatment of overactive bladder symptoms (SUmiT) trials. [19,20] Over half of the patients receiving PTNS therapy in the SUmiT trial, a randomized, double-blinded, sham controlled study, reported moderate or marked improvement in bladder symptoms (54.5% in PTNS patients vs. 20.9% in sham, p<0.001).…”

Section: Discussionmentioning

confidence: 99%

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder

Kızılyel¹,

Karakeçi²,

Ozan³

et al. 2015

Turkish Journal of Urology

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Section: Discussionmentioning

confidence: 99%

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder

Kızılyel¹,

Karakeçi²,

Ozan³

et al. 2015

Turkish Journal of Urology

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“…There are some studies to suggest that patient-related outcomes are similar whether or not there is an urodynamic diagnosis of DO in patients with OAB, following a variety of treatment options. [84][85][86][87] A comparable situation exists for stress incontinence, whereupon non-invasive assessments alone were found to be not inferior to UDS for outcomes at 1 year in a randomised controlled trial (RCT).…”

Section: Effect Of Tests On Subsequent Treatment Pathwaymentioning

confidence: 99%

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Rachaneni

McCooty

Middleton

et al. 2016

Health Technol Assess

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BackgroundUrodynamics (UDS) has been considered the gold standard test for detrusor overactivity (DO) in women with an overactive bladder (OAB). Bladder ultrasonography to measure bladder wall thickness (BWT) is less invasive and has been proposed as an alternative test.ObjectivesTo estimate the reliability, reproducibility, accuracy and acceptability of BWT in women with OAB, measured by ultrasonography, in the diagnosis of DO; to explore the role of UDS and its impact on treatment outcomes; and to conduct an economic evaluation of alternative care pathways.DesignA cross-sectional test accuracy study.Setting22 UK hospitals.Participants687 women with OAB.MethodsBWT was measured using transvaginal ultrasonography, and DO was assessed using UDS, which was performed blind to ultrasonographic findings. Intraobserver and interobserver reproducibility were assessed by repeated measurements from scans in 37 and 57 women, respectively, and by repeated scans in 27 women. Sensitivity and specificity were computed at pre-specified thresholds. The smallest real differences detectable of BWT were estimated using one-way analysis of variance. The pain and acceptability of both tests were evaluated by a questionnaire. Patient symptoms were measured before testing and after 6 and 12 months using the International Consultation on Incontinence modular Questionnaire Overactive Bladder (short form) (ICIQ-OAB) questionnaire and a global impression of improvement elicited at 12 months. Interventions and patient outcomes were analysed according to urodynamic diagnoses and BWT measurements. A decision-analytic model compared the cost-effectiveness of care strategies using UDS, ultrasonography or clinical history, estimating the cost per woman successfully treated and the cost per quality-adjusted life-year (QALY).ResultsBWT showed very low sensitivity and specificity at all pre-specified cut-off points, and there was no evidence of discrimination at any threshold (p = 0.25). Extensive sensitivity and subgroup analyses did not alter the interpretation of these findings. The smallest detectable difference in BWT was estimated to be 2 mm. Pain levels following both tests appeared relatively low. The proportion of women who found the test ‘totally acceptable’ was significantly higher with ultrasonography than UDS (81% vs. 56%;p < 0.001). Overall, subsequent treatment was highly associated with urodynamic diagnosis (p < 0.0001). There was no evidence that BWT had any relationship with the global impression of improvement responses at 20 months (p = 0.4). Bladder ultrasonography was more costly and less effective than the other strategies. The incremental cost-effectiveness ratio (ICER) of basing treatment on the primary clinical presentation compared with UDS was £491,500 per woman successfully treated and £60,200 per QALY. Performing a UDS in those women with a clinical history of mixed urinary incontinence had an ICER of £19,500 per woman successfully treated and £12,700 per QALY compared with the provision of urodynamic to all women. For DO cases detected, UDS was the most cost-effective strategy.ConclusionThere was no evidence that BWT had any relationship with DO, regardless of the cut-off point, nor any relationship to symptoms as measured by the ICIQ-OAB. Bladder ultrasonography has no diagnostic or prognostic value as a test in this condition. Furthermore, despite its greater acceptability, BWT measurement was not sufficiently reliable or reproducible.Trial registrationCurrent Controlled Trials ISRCTN46820623.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 7. See the NIHR Journals Library website for further project information.

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“…These are the most likely areas in which the therapeutic effect of neuromodulation of the bladder by PTNS acts, and this 30-minute stimulus already has a beneficial effect 16,17 . Authors who have studied the effects of PTNS consider it a good therapeutic option for the treatment of OAB because of its low cost and the lack of the side effects of drug therapy 4,10,11,14,15,[18][19][20][21][22][23][24] . In comparison with other electrical stimulation techniques, it has the advantage of generating less discomfort and embarrassment to patients because it is not applied to the genital area 4,10,[22][23][24] .…”

Section: Introductionmentioning

confidence: 99%

Qualidade de vida de mulheres com bexiga hiperativa refratária tratadas com estimulação elétrica do nervo tibial posterior

Fischer-Sgrott

Manffra

Busato

2009

Rev. bras. fisioter.

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Percutaneous tibial nerve stimulation in the treatment of overactive bladder: Urodynamic data

Abstract: PTNS could not abolish DI. PTNS increased cystometric capacity and delayed the onset of DI. Cystometry seemed useful to select good candidates: patients without DI or with late DI onset proved to be the best candidates for PTNS.

Cited by 111 publications

References 18 publications

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

Qualidade de vida de mulheres com bexiga hiperativa refratária tratadas com estimulação elétrica do nervo tibial posterior

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