SAN FRANCISCO: Patients with overactive bladder (OAB) who respond well to 12 weeks of a type of nerve stimulation therapy are likely to have sustained improvement at 12 months if they continue treatments, researchers announced here at the 39th Annual Meeting of the International Continence Society.
The treatment, called percutaneous tibial nerve stimulation (PTNS), involves sending electrical impulses into nerves that control bladder function. Kenneth Peters, MD, Chairman of the Department of Urology at William Beaumont Hospital in Royal Oak, Mich., said patients treated with PTNS and other forms of what is called neuromodulation therapy have a high rate of satisfaction. He said these treatments should be offered early in the course of OAB treatment “rather than uniformly viewed as a treatment of last resort.
It remains unclear which patients are likely to respond best to neuromodulation, he noted. “We don’t have the data yet,” Dr. Peters said. “But, in my opinion, older patients don’t respond as well as younger patients, and that’s why I don’t think we should wait until the bitter end to treat patients using this approach.
Dr. Peters reported the results of a study comparing the effectiveness of once-weekly PTNS and standard drug therapy with daily extended-release tolterodine. An analysis at 12 weeks showed equal objective improvement in OAB symptoms between the drug and PTNS, but patients receiving PTNS reported significant subjective improvements compared with drug therapy.
Thirty-five patients whose OAB symptoms had improved after 12 weekly sessions of PTNS therapy were offered on-going PTNS therapy for another 12 months. Results at 12 months showed sustained significant improvements in 24-hour voiding frequency, which was reduced by an average of 2.8 voids per day, urge urinary incontinence episodes (reduced by an average of 1.6 episodes per day), and nighttime voids that cause people to awaken (reduced by average of 0.8 voids).
Additionally, PTNS produced prolonged quality of life improvements as assessed by both patients and investigators. The investigators observed no serious adverse effects or device malfunctions.
Dr. Peters pointed out that he usually recommends neuromodulatory therapy once the patient has failed a maximum of two medications. “If patients don’t improve after two drugs, additional drugs aren’t likely to work either,” he related.
He said he believes that the sole limitation of PTNS treatment is the time commitment. “Patients need to come to the office to be treated once a week for 12 weeks, and this would be followed by once monthly maintenance therapy,” he said.
He added, however, that the time commitment pays off. “In our trial, the majority of patients who did well at 12 weeks did well at 12 months, and that says a lot.