Transcutaneous tibial nerve stimulation (TTNS) is a relatively new treatment route of electrical stimulation for overactive bladder syndrome (OABS) patients. Percutaneous tibial nerve stimulation (PTNS) is supported with good clinical evidence and is recommended in guidelines for OABS patients (1). Robust evidence is still lacking on the efficacy of TTNS for OABS, despite data have been published showing its efficacy compared to PTNS (2). However, clinicians have started to use it widely, due to its non-invasive and easy application features.

We retrospectively analyzed all our patients that were treated with TTNS for OABS from June 2018 to March 2021. The diagnosis of OABS was made based on patient complaints and bladder diary results. Patients under the age of 18 were not included in the analysis. The OABS patients included in the study group were intolerant to anticholinergic medication. In a routine scheme, TTNS was given twice weekly for 12 sessions at 6 weeks. TTNS was applied transcutaneously by surface electrodes, with a frequency of 10 Hz for 30 minutes in each session. Some patients underwent a weekly maintenance program for 6 weeks depending on  the efficacy of the primary treatment. Patients receiving treatments other than TTNS at the same time were excluded. All patients were also informed about OABS, bladder training and lifestyle modifications and signed informed constent was obtained.
All patients’ age, body mass index (BMI), type of  OABS (wet or dry)  and duration of OABS complaints, demographics, and general characteristics were evaluated. Three day-bladder diary outcomes, the self-administered questionnaires; the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Overactive Bladder V8 (OAB-V8), patient reported symptom severity of the last 3 days by visual analog scale (VAS: 0-10) and 24 hours pad test results were recorded. All outcome parameters were obtained before and after the treatment.

Sixty-six  female patients with OABS were treated with TTNS. Results of 11 patients that discontinued the treatment were excluded, while the remaining 55 patients’ data were included in the study analysis. Fifty-one of the patients had wet type  and 4 of the patients had dry type of OABS. None of the patients were on any medication for OABS at the time TTNS treatment started. None of the patients had any adverse event during the TTNS procedure. The effectiveness of TTNS treatment was evaluated with 3 day-bladder diary outcomes , 24 hours pad test and questionnaire scores. As a statistical method, we used mean ± SD(standard deviation) in continuous variables and Paired Samples t-Test was performed among dependent groups. (Table 1)

TTNS treatment for OABS in female patients was effective in reducing incontinence and urgency symptoms and improvement was observed in all of the outcome parameters. Nocturia, nocturnal incontinence and pad test were the only outcome results that were not statistically significant, while the rest had statistically significant improvement. Our results are limited for comparison as we didn’t have a control group. However, cumulative data from clinical experiences with TTNS, can give clinicians a better perspective for this relatively new treatment. Our impression from clinical experience is that TTNS is well tolerated by the patients and is a preferred method of treatment by patients.

Results from our database showed that TTNS is safe and effective in female patients with OABS. Randomized controlled trials in larger patient populations are needed to prove this efficacy. TTNS and its clinical implications like parameters of electrical stimulation, treatment schedules and efficacy in other patient populations are subject to explore for future trials.

Lightner DJ, Gomelsky A, Souter L et al: Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline amendment 2019. J Urol 2019; 202: 558.
Ramírez-García I, Blanco-Ratto L, Kauffmann S, Carralero-Martínez A, Sánchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: Randomized control trial. Neurourol Urodyn. 2019 Jan;38(1):261-268. doi: 10.1002/nau.23843. Epub 2018 Oct 12. PMID: 30311692.