Predictors of successful percutaneous tibial nerve stimulation (PTNS) in the treatment of overactive bladder syndrome

Introduction and hypothesis: Multiple publications have demonstrated the efficacy of percutaneous tibial nerve stimulation (PTNS) for overactive bladder syndrome (OAB). However, patient characteristics associated with successful treatment have not been well established. The aim of this study was to identify prognostic factors for successful PTNS treatment.

Methods: This was a retrospective chart review of women who underwent PTNS therapy for OAB between January 2011-Decemeber 2017. Treatment success was defined by subjective improvement according to patient self-report and objective bladder diary parameters including the intervoiding interval, nocturia episodes and urgency urinary incontinence (UUI) episodes per day, before and after PTNS treatment. Baseline symptoms were dichotomized for each symptom based on severity.

Results: One hundred sixty-two women with a mean age of 72.7 ± 11.3 years and BMI of 28.5 ± 7.1 were included in the study. There was a statistically significant improvement in all three OAB symptoms after treatment. Multivariable analysis revealed that a history of depression and anxiety was associated with subjective improvement, whereas decreased subjective improvement was associated with a history of hypertension, prior intravesical onabotulinnumtoxinA injection and sacral neuromodulation. While dichotomizing subjects into two groups defined by < 50% versus ≥ 50% improvement, depression/anxiety, urodynamic volume at first sensation to void and more severe baseline urgency urinary incontinence severity were all significant predictors of subjective improvement.

Conclusions: Among women treated with PTNS for refractory OAB, a history of depression/anxiety and severe baseline urgency urinary incontinence were positive predictors of a successful PTNS outcome.