Acute Effects of Transcutaneous Tibial Nerve Stimulation on Autonomic Nervous System Activity in Healthy Volunteers: An Exploratory Study.

Aim: Percutaneous tibial nerve stimulation is used to decrease incontinence in chronic neurogenic bladder. We report the findings from a subset of patients in a randomized control trial of transcutaneous tibial nerve stimulation (TTNS) for bladder neuromodulation in acute spinal cord injury (SCI) in whom heart rate variability (HRV) was recorded before and after cystometrogram (CMG). The aim was to correlate autonomic nervous system (ANS) changes associated with the CMG changes after the trial using HRV analyses.Methods: The study was a double-blinded sham-controlled 2-week trial with consecutive acute SCI patients admitted for inpatient rehabilitation, randomized to TTNS vs. control sham stimulation. Pre- and Post- trial CMG were performed with concurrent 5-min HRV recordings with empty bladder and during filling. Primary outcomes were changes with CMG between/within groups and associations to the HRV findings.Results: There were 10 subjects in the TTNS group and 6 in the control group. Pre-trial baseline subject characteristics, blood pressures (BPs), and CMG were similar between groups. In both groups, the pre-trial systolic BP increased during filling CMG. After the trial, the control group had significantly increased detrusor pressure and counts of detrusor-sphincter dyssynergia on CMG, not seen in the TTNS group. Also, the control group did not maintain rising BP post-trial, which was observed pre-trial and remained in the TTNS group post-trial. HRV was able to detect a difference in the ANS response to bladder filling between groups. Post-trial HRV was significant for markers of overall increased parasympathetic nervous system activity during filling in the controls, not seen in the TTNS group.Conclusion: Preliminary evidence suggests that TTNS in acute SCI is able to achieve bladder neuromodulation via modulation of ANS functions.Clinical Trial Registration:clinicaltrials.gov, NCT02573402.

To evaluate effectiveness of transcutaneous tibial nerve stimulation (TTNS) for treating adults with overactive bladder (OAB) of idiopathic or neurogenic origin, using a systematic review of the literature. Systematic searches of four databases were undertaken between 1980 and 2017. Included studies investigated effects of TTNS on OAB. Study selection, data extraction, quality appraisal was performed by two independent reviewers. Narrative analysis was undertaken where meta-analysis was not possible due to study heterogeneity. Meta-analysis of RCTs was performed using a fixed effects model. Ten RCTs and three prospective cohort studies involving 629 participants were reviewed. Meta-analysis of two trials comparing TTNS with sham showed mean reduction in total ICIQ Urinary Incontinence Short Form (ICIQ-UI SF) associated with TTNS of -3.79 (95% CI -5.82, -1.76; P = 0.0003, I2 = 25%). Narrative review showed TTNS and antimuscarinic treatment were equally effective (four trials), TTNS provided greater benefit for OAB symptoms than behavioral interventions (two trials), tibial nerve, and sacral foramen stimulation were equally effective but combined stimulation was most effective (one trial). Significant improvements in OAB symptoms were reported by 48-93% participants and UI cure rates of 25-45%. No adverse events were reported. Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups, most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.

Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30minutes for 12weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group 1 and group 2 (P<.001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week. What's known TTNS is one of the effective alternative treatments in resistant OAB treatment. What's new As the number of sessions is increased in TTNS treatment, the success of the treatment can increase.

The purpose of this study was to evaluate the efficacy of daily transcutaneous tibial nerve stimulation (TTNS) versus weekly percutaneous tibial nerve stimulation (PTNS) on the quality of life of patients with idiopathic overactive bladder (OAB). The study was designed as a randomized controlled trial. The diagnosis of OAB was made on the basis of clinical symptoms, and urodynamic tests were performed to check whether uncontrolled contractions of the derusor during bladder filling were responsible for the OAB symptoms. The tests used to assess symptoms and quality of life were Overactive Bladder Questionnaires (OAB-q) SF. The patients were divided into 2 groups of 30 patients each. The first group was treated with TTNS every day for 3 months and the second group with PTNS once a week, also for 3 months. Stimulation with both TTNS and PTNS led to the reduction of all clinical symptoms of OAB and improved quality of life, with statistical significance (P<0.05) and with no side effects. When comparing these two groups, the improvement was statistically more significant in the group treated with PTNS. When the quality of life scores and symptoms were compared to the type of treatment, it was found that the improved quality of life parameters and the reduced OAB symptoms were more statistically significant in the treatment with PTNS than TTNS therapy (P<0.001). The results of the study suggest good efficacy of both TTNS and PTNS in the treatment of OAB. Better effects are achieved with weekly PTNS, as it leads to a statistically significant reduction in symptoms as well as an improvement in quality of life, without side effects.

Background: Pelvic health physical therapists (PTs) use a variety of treatment approaches to treat overactive bladder (OAB). Transcutaneous tibial nerve stimulation (TTNS) uses peripheral neuromodulation to deliver electrical current to the tibial nerve for the treatment of OAB. The purpose of this survey was to identify current practice patterns and barriers to implementation of TTNS. Methods: One hundred and seventy-eight surveys were electronically submitted by PT members of American Physical Therapy Association (APTA) Academy of Pelvic Health Physical Therapy (APHPT). Results: The use of TTNS by pelvic health PTs in the United States (US) varies widely. Only 30.6% of therapists noted using TTNS as first line therapy along with behavioral and lifestyle modifications. The most common reasons therapists do not use TTNS include precautions or contraindications and patient choice. Some therapists reported unfamiliarity with the research as a reason for not using TTNS. A significant association was found between a PT not being familiar with the research and how often TTNS was used ( P = .0111). The majority of therapists in this survey position electrodes on a single limb and used a pulse width of 200 or 250 microseconds (µsec), and a pulse frequency of 10 to 12 hertz (Hz) for 30 minutes. This aligns with current evidence. Discussion: TTNS should be considered in a pelvic PT treatment algorithm for OAB. Evidence suggests that providers increase their knowledge of TTNS and educators include instruction about TTNS in evidenced-based training in order to apply the modality effectively.

Objective:There is no consensus on the effectiveness, the sites of application and, optimal dosage and frequency of attendance of transcutaneous tibial nerve stimulation (tTNS) on the treatment of overactive bladder. The aim of the study was to evaluate the long-term effectiveness of eight weeks lasting transcutaneous tibial nerve stimulation (TNS) treatment and its effects on the quality of life of the patients.Method:In this cross-sectional study conducted between September 2022 and December 2023 at a tertiary care center, 56 patients with overactive bladder were allocated to receive transcutaneous tibial nerve stimulation or sham therapy weekly for eight weeks; 30 of them had transcutaneous tibial nerve stimulation (study group) and remaining 26 patients formed the control group. Overactive Bladder Questionnaire Awareness tool V8 (OAB-v8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), and Visual Analog scale (VAS) scales were used for evaluation of bothersome degree. Patients who received tTNS therapy have been evaluated at 3rd and 6th and 12th months and time-dependent change in the Incontinence Quality of Life Questionnaire (I-QOL) scores were determined.Results:After eight weeks of tibial nerve stimulation treatment, a statistically significant increase was found in the OAB -V8, ICI-Q and VAS scores compared to the sham therapy group (p<0,05). Minimum 50% increase was achieved in I-QOL scores at the 3rd and 6th months of treatment, but the improvement was less than 50% at the12th month.Conclusions:Transcutaneous TNS is an effective treatment option for women with OAB, but its long-term effectiveness is insufficient. Therefore, rescue sessions to be held at 6-8 month intervals can be used to increase patient satisfaction.

BackgroundTranscutaneous tibial nerve stimulation (TTNS) and percutaneous tibial nerve stimulation (PTNS) are effective and safe therapies for overactive bladder (OAB) syndrome in adults. However, few randomized sham-controlled trials have been conducted in a pediatric population. To our knowledge, both therapies never have been compared in children.AimThe aim of the complete study is twofold: (1) to assess the efficacy of TTNS therapy on bladder symptoms after 12 weeks of treatment in a pediatric population with idiopathic overactive bladder syndrome (iOAB) and/or nocturnal enuresis (part I) and (2) to assess the effect of TTNS compared to PTNS (part II). In this article, we aim to present the protocol of the first part of the TaPaS trial (TTNS, PTNS, sham therapy).MethodsPart I of the TaPaS trial is set up as a single-center randomized-controlled trial. Children, aged from 5 to 12 years with iOAB and/or nocturnal enuresis, are assigned to two groups by computer-generated randomization: TTNS therapy (intervention) and sham therapy (control). The primary outcome is the percentage difference in average voided volume (AVV) between baseline and after 12 weeks of treatment. Secondary endpoints are the percentage difference in supervoid volumes, number of urinary incontinence episodes/24 h and in voiding frequency, the difference in parent reported outcomes between baseline and after 12 weeks of treatment, and the duration of clinical response.DiscussionWe hypothesize that TTNS is a non-inferior treatment for iOAB in children compared to PTNS therapy. Since literature is inconclusive about the efficacy of TTNS in a pediatric population, a sham-controlled RCT on TTNS will be conducted (part I). A protocol for a prospective randomized sham-controlled trial has been developed. Enrolment has started in November 2018. Study completion of part I is expected by August 2021.Trial registrationClinicalTrials.gov NCT 04256876. Retrospectively registered on February 5, 2020.

Background: Overactive bladder (OAB) is common in patients with multiple sclerosis (MS) with a limited number of treatment options. Objective: To investigate the effect of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on OAB symptoms in female MS patients. Methods: This study was conducted at the outpatient MS clinic in Istanbul. At baseline bladder diary, post-voiding residue (PVR), OAB, and Qualiveen Scales (QoL: Quality of Life; Siup: Specific Impact of Urinary Problems on QoL) were assessed. Patients were allocated to receive TTNS or PFMT daily for 6 weeks and reevaluated using the same tests. Results: Fifty-five patients (TTNS = 28, PFMT = 27) were included. Compared with baseline, both TTNS and PFMT groups improved in terms of OAB (p = 0.0001, p = 0.0001), Qualiveen-siup (p = 0.0001, p = 0.0001), Qualiveen-QoL (p = 0.002, p = 0.006), PVR (p = 0.0001, p = 0.21), frequency (p = 0.0001, p = 0.69), nocturia (p = 0.0001, p = 0.19), urgency (p = 0.0001, p = 0.0001), and urge incontinence (p = 0.0001, p = 0.0001). Between-group comparisons showed significant differences in 24-hour frequency (p = 0.002) in favor of TTNS. Conclusion: Our study demonstrates the efficacy of both TTNS and PFMT for managing OAB symptoms in MS, associated with a significant impact on QoL, but did not show superiority of the methods. Further studies are needed to explore differences between these two non-invasive treatments.

Introduction: Overactive bladder (OAB) is prevalent among older adults and treatment options include transcutaneous tibial nerve stimulation (TcTNS). The objective of this study is to evaluate the effectiveness of at home self-administered TcTNS therapy in older adults with OAB. Methods: A prospective observational study of 37 women, 65 years of age and older, with OAB was conducted. Previous continence surgery, pelvic organ prolapse of &gt;/= to POP-Q stage III, recurrent urinary tract infections, neurogenic OAB or cognitive deficits were excluded. Subjects were instructed and treated themselves at home daily with a TcTNS for one month. Efficacy was evaluated using a 3-day bladder diary and Quality of life questionnaire (oab-q). A positive treatment response was at least a 50% reduction in episodes of urinary urgency. STATA V.12.1 was used for data analysis, with a p-value of 5%. Results: A total of 37 women were studied. The mean age was 79 years (range: 68 – 90). No adverse effects were reported. After the monthly TcTNS treatment, there was a significant improvement in all the bladder diary parameters quality of life survey, compared to the baseline data (p&lt;0.05). The overall response to treatment was 53%, and 13% of patients reported no episodes of incontinence post TcPTNS. Conclusions: TcTNS is an effective tool for controlling symptoms of OAB in older women. Daily at home stimulation for a month achieves therapeutic effects similar to those described after weekly or bi-weekly stimulation over the course of three months.

Introduction: Overactive bladder is a syndrome of increased urinary frequency and nocturia with or without incontinence in absence of obvious pathology. Transcutaneous Tibial Nerve Stimulation (TTNS) is one of the neuromodulation used to treat overactive bladder. We report the medical rehabilitation program in overactive bladder post-Transurethral Resection of The Prostate (TURP). The medical rehabilitation program consisted of pelvic floor muscle exercise and TTNS that may reduce the overactive bladder symptoms. This study aims to determine whether TTNS and pelvic floor muscle exercise will reduce overactive bladder symptoms after TURP. Case Presentation: a 40-year-old Asian man who developed overactive bladder symptoms after TURP had the medical rehabilitation program consisting of pelvic floor muscle exercise and TTNS. The pelvic floor exercise was given twice a day and TTNS was given twice a week for 12 cycles and repeated for 12 cycles. He was followed up by Over Active Bladder Symptoms Score (OABSS) to assess the severity of symptoms. Conclusion: The medical program rehabilitation that consisted of pelvic floor muscle exercise and TTNS reduced 50% in the severity of overactive bladder symptoms after TURP. No complications have been reported. Need further research to know the definitive result.

Background. Transcutaneous tibial nerve stimulation is a simple, non-invasive treatment, which can be used to treat faecal incontinence. Optimal treatment regimen is not known and various stimulation regimens are used in different centers. The aim of this prospective study was to evaluate the efficacy of twice weekly transcutaneous tibial nerve stimulation for faecal incontinence patients, who have failed to respond to maximal conservative treatment. Material and methods. Twenty patients with faecal incontinence resistant to maximal conservative therapy were treated with transcutaneous posterior tibial nerve stimulation twice a week for six weeks. The number of the bowel movements per two weeks and the Cleveland Clinic Florida Feacal Incontinence Score were assessed before and after the treatment. The quality of life was estimated using the Faecal Incontinence Quality of Life questionnaire and the Gastrointestinal Quality of Life Index. Results. Effect was seen in 55% of patients. Two-week faecal incontinence episodes decreased from median 4 (2–84) to 2 (0–56) (p = 0.002). The mean Cleveland Clinic Florida Faecal Incontinence score improved from 10.9 ± 4.34 to 7.8 ± 3.96 (p = 0.002). The quality of life improved significantly after the treatment. The therapy was well tolerated and no participant experienced any adverse event. Conclusions. Transcutaneous tibial nerve stimulation twice a week for 6 weeks may be efficacious in patients with faecal incontinence, who have failed to respond to maximal conservative treatments.

Sexual dysfunction (SD) is common in female patients with multiple sclerosis (MS) reporting overactive bladder (OAB) symptoms. The aim of the study was to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on SD in female patients with MS reporting OAB symptoms. Patients with overactive bladder and SD were allocated to receive TTNS or PFMT daily. Overactive bladder symptoms, sexual functions, and sexual quality of life were assessed at baseline and 6th weeks. Female Sexual Function Index (FSFI), Overactive Bladder Questionnaire (OABv-8), and Sexual Quality of Life-Female (SQoL-F) questionnaires were used. Thirty patients (TTNS = 10, PFMT = 20) were included in the study. Compared to baseline, total FSFIOABv-8, and SQoL-F scores improved in both TTNS (p = 0.005, p = 0.011, p = 0.444, respectively) and PFMT (p = 0.002, p = 0.001, p = 0.001, respectively) groups. Between-group comparisons did not show any significant differences. This study demonstrates the efficacy of both TTNS and PFMT for improving sexual function in female MS patients with OAB symptoms, but did not show superiority of any particular method. Further studies are required to investigate the differences between these two non-invasive methods.

382 Transcutaneous tibial nerve stimulation in children and adolescents with neurogenic bladder and bowel dysfunction

Transcutaneous tibial nerve stimulation (TTNS) is used to treat overactive bladder (OAB) syndrome. We hypothesized that TTNS instruction delivered via telehealth (TH) would be as effective as face-to-face (FtF) instruction in improving OAB symptoms. In this prospective cohort study, 99 women with OAB self-selected FtF (n = 79) or TH (n = 20) instruction for TTNS setup. Groups received standardized education on device placement and usage. Primary outcome was the between-group comparison of change in International Consultation on Incontinence Questionnaire (ICIQ-SF) scores at 3 and 12months. Secondary outcomes included between-group comparisons of Patient Global Impression of Improvement (PGI-I) score at 3months and treatment persistence at 12months. Between-group differences were analyzed using Student's t tests. At 3months, FtF and TH groups showed mean ICIQ-SF score reductions of 2.3 ± 1.8 and 1.9 ± 1.6 points respectively (between-group difference 0.4 points; 95% CI -1.79, 2.59; p = 0.60). PGI-I scores indicated improvement in 48.1% of FtF and 50.0% of TH participants. At 12months, treatment persistence was 60.8% for FtF and 55.0% for TH groups. Among continued treatment responders, sustained improvement was observed, with mean ICIQ-SF reductions of 3.6 ± 2.4 points (FtF) and 4.0 ± 2.6 points (TH) from baseline (p = 0.48). Progression to third-line therapies was comparable between groups (FtF 24.0%, TH 25.0%). Telehealth shows promise as an effective method for initiating TTNS treatment for OAB, providing comparable outcomes with FtF instruction. The approximate 50% response rate and sustained benefits among responders support TTNS as a viable treatment. Findings support broader implementation of TH TTNS instruction, potentially improving treatment access for suitable patients.

Résultats et observance de la stimulation transcutanée du nerf tibial dans l’hyperactivité vésicale de la maladie de Parkinson idiopathique. Étude rétrospective.