Patients rarely continue percutaneous tibial nerve stimulation (PTNS) for overactive bladder (OAB) after 3 years, according to new study findings presented during the AUA2021 Virtual Experience.
Of 146 patients treated with PTNS from 2014 to 2017 at Stony Brook Medical Center in Stony Brook, New York, 108 patients (74%) completed the initial 12 week course of therapy, but only 76 (52%) continued with monthly maintenance therapy. After 3 years, a mere 16 patients (11%) still underwent PTNS, Chris Du, MD, and colleagues from Stony Brook Medicine reported in a poster presentation. The median duration of PTNS therapy was 147 days.
In multivariate analysis, only symptom improvement and neurological history were significantly associated with continuing PTNS. Symptom improvement was reported by 100% of patients who remained on PTNS at 3 years compared with 60% of patients who dropped out. A neurologic history was present in 56% of patients who adhered to PTNS compared with 32% who dropped out. It is likely that the increased urologic risk of neurogenic bladder in these patients leads to higher rates of compliance, the investigators noted. Other relevant factors, such as gender, race, Medicare coverage, smoking status, diabetes mellitus, median household income, and distance to clinic did not influence PTNS persistence.
Among the 130 patients who dropped out, the most commonly cited reasons for cessation included worsening of urinary symptoms (51 patients), time commitment (12), request for alternative treatment (12), medical comorbidities (10), and insurance issues (7).
“Despite reported symptom improvement, overall compliance remains low with this third line treatment for OAB,” Dr Du’s team concluded.
Du C, Berg W, Jeong R, Lee E, Niu E, Cohen T, Kim J. Three-year follow-up: Patients have poor long-term compliance rates using percutaneous tibial nerve stimulation. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Abstract MP52-13.
Du C, Berg W, Siegal AR, Huang Z, Jeong R, Hwang K, Kim J. Real-world compliance with percutaneous tibial nerve stimulation maintenance therapy in an American population. Urology. 2021 Jul;153:119-123. doi:10.1016/j.urology.2021.02.005