Hypothesis / aims of study
Overactive bladder (OAB) syndrome is a symptom complex characterized by sudden urge to urinate, frequent urination, nocturia, and urgency incontinence without any identifiable organic cause. It is a commonly observed condition that significantly affects the quality of life [1,2].
In the 2023 published guidelines by ICS and EUA for the treatment of OAB, transcutaneous posterior tibial nerve stimulation (T-PTNS) is recommended to be administered following initial treatments. Antimuscarinics play an important role in the maintenance treatment of OAB. In light of the current recommendations in the guidelines, it is important to obtain evidence regarding the comparison of the efficacy of antimuscarinics and T-PTNS treatments to determine which one should be prioritized after the initial treatment. There are limited studies comparing these two methods [2,3].
Study design, materials and methods
Thirty-four OAB cases between the ages of 18 and 80 were randomized to receive either T-PTNS or oral solifenacin treatment. All cases underwent pre- and post-treatment basic urogynecological evaluation, bladder diary recording, and quality of life questionnaires (OAB-V8, l-QQL, IIQ-7, UDI-6). To stimulate the tibial nerve, T-PTNS group were connected to a low voltage stimulator (TENS URO stim 2 101453 [Ref.: 170–101453] Germany) twice a week for 30 minutes per session, totaling 12 sessions. The drug group received 5 mg solifenacin once a day. Statistical analysis was performed using SPSS 20.0.
Results
Significant improvements were observed in symptom scores and quality of life outcomes in patients following both T-PTNS and solifenacin treatments. However, patients in the T-PTNS group showed significantly lower levels of urgency, nocturia, and incontinence episodes. The quality of life scores, as measured by IIQ-7, OAB-V8, and l-QQL, were also significantly higher in the T-PTNS treatment group compared to the medication group. Both intra-group and inter-group treatment results are shown in Table 1.
Table 1. is attached as an image file to the figures section.
Interpretation of results
In the literature, improvement in nocturia, urgency, urge incontinence episodes, and pad usage has been reported in patients with OAB treated with TTNS. In a study, TTNS and solifenacin treatments were compared in the OAB group. Both groups showed improvement in bladder diary and quality of life; there was no significant difference between the results. However, it was reported that participants discontinued the use of solifenacin due to dry mouth, while no side effects were observed in the TTNS group. In our study, no side effects were reported by participants in both groups. In studies comparing the efficacy of PTNS and antimuscarinics, PTNS has been found to have a similar effect to antimuscarinics in reducing general symptom scores such as urinary frequency and urgency, while being significantly more effective in reducing urge UI attacks [2,3].
Despite being a non-invasive option, T-PTNS treatment requires the assistance of healthcare personnel for each treatment session, as it involves a testing process and determination of the treatment dose. Therefore, the patient needs to visit the hospital for each session. While antimuscarinics do not have such a disadvantage, the side effects that may lead to treatment discontinuation in the medium and long term can affect sustainability.
The presented study includes short-term results. There are limited studies on long-term outcomes of T-PTNS treatment, and there is not enough information regarding maintenance treatment regimens. Long-term follow-up of the cases included in this study will contribute to the data on T-PTNS treatment.