Long term safety, continuation rates and subjective and objective success of Posterior Tibial Nerve Stimulation for Overactive Bladder

Introduction: Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods: We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results: We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS 'top ups' as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain. 28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion: PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS 'top ups' and only 1 in 5 are continuing with PTNS for long term management of their OAB.