Tibial Nerve Stimulation

Abstract
Purpose: Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS) using adhesive skin electrodes is not commonly used due to its low efficacy. Our objective was to verify whether the combination of TPTNS with low dose Trospium chloride in the treatment of females with overactive bladder (OAB) would be more effective than TPTNS alone after failure of behavioral therapy. Materials and Methods: We randomized 30 women with OAB, into two groups, 15 patients each: Group I received 30 minutes TPTNS, three times a week; Group II received TPTNS three times a week, plus Trospium chloride (20 mg once daily) for eight weeks. Patients were evaluated using Overactive Bladder Symptom Score questionnaire (OABSS), Impact Questionnaire-short form 7
In a short term study, posterior tibial nerve stimulation (PTNS) was found to have comparable effects to antimuscarinics with a better side effect profile.(4) PTNS has been used as a chronic treatment to improve OAB, with a success rate between 60 and 80%, while transcutaneous posterior tibial nerve stimulation (TPTNS) has a success rate of 48-68%(5).
PTNS requires placement of a fine-needle electrode into the inner aspect of theankle. This low-risk procedure has, however, common side effects, such as minor bleeding, mild pain, or skin inflammation at the treatment site(6). However, TPTNSis especially interesting because it might reproduce the effectiveness of PTNS while minimizing risk of infection, pain and bleeding beside being cost effective and suitable for adults and children.(7–10)Studies have demonstrated the potential efficacy of combination treatments(11)which led to the aim of this study,verifying whether the combination of TPTNS with low dose Trospium chloride in the treatment of females with idiopathic OAB would be more effective than TPTNS alone after failure of behavioral therapy.
Patients and
TENS inhibits the detrusor by central reflex. Since the success rate of TPTNS is lower than the PTNS in the literature, we combined low dose anticholinergic (20 mg Trospium chloride) with it to enhance its success rate. Our aim was to save the patients from side effects of full dose anticholinergics. Trospium chloride is considered as one of the agents with fewer side effects.(19) Our patients did not report any side effects related to the small dose of the drug.
Investigators found that subjective improvement in symptoms and QoL scores is more important than the objective improvement.(20,21) According to another study PTNS subjects achieved statistically significant improvement in bladder symptoms with 54.5% reporting moderately or markedly improved responses from baseline Vs 20.9% of sham subjects.(20) In the present study both OABSS and IIQ-7 scores showed a significant improvement in both groups of patients but more in combination group.
In the present work, the voiding diary showed a more significant reduction of frequency in group I. Govier et al studied 53 patients, the reduction in the number of daytime urination was 25% and improvement of quality of life