Neurogenic bladders can suffer from overactivity, underactivity or dyssynergia depending on the level of the initial lesion. These symptoms can lead to severe alterations of the upper urinary tract. One of the first-line treatments is the transcutaneous tibial posterior stimulation (TTNS), which was demonstrated to be efficient on urodynamics. But it is an invasive, expensive and sometimes not patient-accepted examination, contrary to the uroflowmetry. The aim of this study is to assess the feasibility of a follow-up with a uroflowmetry when treated by TTNS and show that the maximum flow rate increased after treatment, displaying a better detrusor contraction.

In total, 38 patients with neurogenic bladder undergoing a 12-weeks TTNS treatment and with 2 uroflowmetries interpretable before and after treatment were included. 
The maximum flow rate, the urinated volume and the post-void residual were retrieved from the uroflowmetry. The Urinary Symptom Profile (USP)-score and the urinary discomfort were asked at each appointment.
USP-score was divided into three categories and patients are asked to rate their symptoms : dysuria, (rated on 9), overactive bladder (rated on 21) and urinary incontinence (rated on 9). Urinary discomfort was a global scale from 0 to 10 (maximal discomfort).

Out of the 38 patients, 31 had overactive bladder and 7 underactive bladder. 16 of them were men and 22 women. 
Maximum flow rate increased from 17,53 ml/s to 18,26 ml/s, as well as the post-void residual (from 76,97 ml to 79,16 ml). Urinated volume is decreased from 241,4 ml to 193,66 ml (significant to statistical tests). 
Concerning subjective symptoms, USP-score regarding urinary incontinence improved from 2,42 to 1,51, overactive bladder from 10,12 to 7,62, dysuria from 2,16 to 1,76. For the global urinary discomfort, it improved from 6,5 to 5 after TTNS. Results on subjective questionnaires are all significant to statistical tests.

The increase of the cystomanometric capacity and the delay of the detrusor overactivity due to TTNS explains the reduction of the urinated volume and the increase of PVR. Increased Qmax might show a better voluntary bladder contraction, with a restraint due to the lack of abdominal pressure measurement during voiding.
Patients are however feeling a true improvement of their symptoms and are less bothered by their urinary symptoms.

Results on uroflowmetry are consistent with those already observed on urodynamics, mostly concerning the decrease of the urinated volume after TTNS treatment. Studies with abdominal pressure measure during voiding and most importantly instructions to consult with full bladder to avoid a lot of uninterpretable uroflowmetries would be recommended.