Real-world Compliance With Percutaneous Tibial Nerve Stimulation Maintenance Therapy in an American Population

Abstract

To evaluate percutaneous tibial nerve stimulation (PTNS) maintenance therapy dropout rates and identify factors associated with compliance in an American population. We retrospectively queried our PTNS database for patients from 2014-2019. Demographic, relevant clinical, and visit data were collected. Maintenance therapy was patient-driven and frequency of sessions was tapered based on symptomology. Upon completion of 12 initial sessions, we assessed dropout from maintenance at 3, 6, 9, and 12 months. Multiple variables were tested for correlation with dropout in patients continuing maintenance therapy for 1 year vs those who dropped out. One hundred and sixty-three PTNS patients were identified, of which 104 completed initial therapy and 81 proceeded with maintenance therapy. At 3, 6, 9, and 12 months, maintenance continuation rates were 77.8% (63/81), 58.0% (47/81), 45.6% (37/81), and 39.5% (32/41), respectively. Primary reasons for dropout were worsening of urinary symptoms/lack of efficacy (n=21), time commitment (n=9), loss of insurance (n=5), medical comorbidities (n=4), request for alternative OAB treatment (n=2), and unknown (n=8). On both univariate and multivariate analysis, perceived symptom improvement (P<.01; HR=0.02, P< .01) was associated with continuing maintenance therapy. On only univariate analysis, neurological history (P=.02) and multiple sclerosis history (0.02) were associated with continuing therapy. Only 39.5% of patients continue to undergo maintenance PTNS therapy after 1 year. Future studies are required to understand and ameliorate factors for low compliance in PTNS maintenance therapy.