Abstract
OBJECTIVE:To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance.METHODS:This multi-arm randomized controlled trial enrolled 137 adult women (61.0±9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885.RESULTS:The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0±1.6 vs. 1.4±1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7±1.4 vs.1.4±2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2±3.5 vs. 9.0±5.1; p=0.026) and placebo (8.2±3.5 vs. 7.9±2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5±1.8) when compared with the one leg, twice a week protocol (1.9±2.0) and placebo (1.7±1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3±1.2 vs.1.9±2.0; p=0.011).CONCLUSION:One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.
Highlights
Transcutaneous electrical nerve stimulation (TENS) of the tibial nerve is a non-invasive, safe, low-cost, easy-to-apply method, with good adherence among patients, which helps to reduce symptoms of urgency, incontinence, daily urinary frequency, and nocturia [1,2,3]
The groups were initially similar in age (p=0.43), body mass index (p=0.12), number of pregnancies (p=0.62), and daily urinary frequency (p=0.53)
We proposed to analyze the periodicity of electrical stimulation and the number of legs in which the TENS was applied and our results suggest that different protocols may achieve better results depending on the outcome of interest
Summary
Transcutaneous electrical nerve stimulation (TENS) of the tibial nerve is a non-invasive, safe, low-cost, easy-to-apply method, with good adherence among patients, which helps to reduce symptoms of urgency, incontinence, daily urinary frequency, and nocturia [1,2,3]. Accepted for publication on June 15, 2021. Many studies on transcutaneous electrical stimulation and urinary incontinence have sought to define optimal electrical parameters or protocols for treatment, little is known about the dose of application or positions of the electrodes [5,6,7,8]. There is no standardized dose for TENS applications, which varies from one to three times per week [10,11]
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