Impact of Weekly Application Frequency on the Efficacy of Tibial Nerve Stimulation Therapy in the Treatment of Overactive Bladder.

introduction and hypothesisElectrical stimulation, which has become widely used in the treatment of overactive bladder (OAB) to reduce symptoms, is a treatment method included in guidelines. However, there are shortcomings in the standardization of its application. This study is aimed at investigating the response to different frequencies of posterior tibial nerve stimulation (PTNS) in this context.

methodsMale and female patients aged 18-65 with refractory OAB were included in the study. Participants were divided into two groups. One group received PTNS treatment once a week for 12 weeks (group 1), whereas the other group received PTNS treatment twice a week (group 2). All patients completed a 3-day voiding diary before starting PTNS treatment, recording frequency, nocturia, urgency, urge incontinence, and voided volume values. The International Continence Interrogation Questionnaire Short Form (ICIQ-SF), Overactive Bladder Questionnaire (OAB-V8), and Overactive Bladder Questionnaire Short Form (OAB-q SF) were completed. Patients filled out the same voiding diary and questionnaires at the 4th and 12th weeks.

resultsWhen the scores at the 4th and 12th weeks were compared with the baseline, there was a significant difference in both groups (repeated measures analysis of variance [ANOVA], p < 0.001). Similarly, the scores for OAB-q SF, ICIQ-SF, and OAB-V8 at the 4th and 12th weeks were significantly different in both groups compared with baseline (ANOVA, p < 0.001). When response rates were evaluated, the 12th-week results were similar in the two groups for all questionnaires (p > 0.05). However, there was a difference in the ICIQ-SF and OAB-V8 forms. At the 4th week, the results for these two questionnaires differed between the groups (p = 0.03, 0.002). When the treatment response was compared, the difference from baseline in the frequency and urgency parameters at the 4th week was greater in group 2, and this difference was statistically significant (p = 0.031, 0.015). However, this was not the case for the 12th week, where no significant difference was found between the groups (p = 0.12, 0.22).

conclusionsThis study was conducted to address the lack of standardization in PTNS, a treatment method strongly recommended in European urology guidelines for the treatment of OAB. Significant improvements in voiding diary parameters were observed in both treatment groups, but the group receiving two sessions per week showed faster improvement at the 4th week, although the results were similar by the 12th week. Early improvement may be associated with a faster neuromodulation response in patients with severe symptoms. These results highlight the importance of individualized treatment protocols and suggest that further prospective studies might be needed to assess the long-term effectiveness of PTNS.