Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care

David R Staskin, Kenneth M Peters, Scott MacDiarmid, Neal Shore, William C de Groat, David R Staskin, Kenneth M Peters, Scott MacDiarmid, Neal Shore, William C de Groat

Abstract

Overactive bladder affects millions of adults, with profound personal and economic costs. Although antimuscarinic drugs can cause a reduction in voiding symptoms, the effect is modest, and many patients are intolerant of the side effects, or do not experience sufficient relief. For these patients, the modulation of bladder reflex pathways via percutaneous tibial nerve stimulation (PTNS) or via implanted sacral nerve stimulation (SNS) has been acknowledged as a logical next step in the algorithm of care. This review examines the mechanism of action, the relative benefits, adverse effects, and costs of percutaneous nerve stimulation compared to other treatment modalities.

Figures

Fig. 1
Fig. 1
Percutaneous tibial nerve stimulation in the outpatient setting. Reprinted withpermission fromPeters etal [••]
Fig. 2
Fig. 2
OAB treatment algorithm, progressing from the least expensive and noninvasive therapy of lifestyle and behavioral changes, through drug therapy, intermittent PTNS, surgically implanted SNS, and finally surgical interventions. (*Botulinum is not in the treatment algorithm as it is not currently an FDA approved therapy for idiopathic OAB.)
Fig. 3
Fig. 3
Relative costs of therapeutic options for overactive bladder

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