Abstract
Objective:Overactive bladder (OAB) affects 16.9% of women in the United States. Percutaneous tibial nerve stimulation (PTNS) is a third-line treatment for patients who are refractory to behavioral and pharmacologic therapies. We aimed to evaluate the effects of PTNS on urinary symptoms in patients diagnosed as having refractory OAB and investigate the cost of medications and clinical visits before and after PTNS treatment.Material and Methods:We reviewed 60 women with refractory OAB treated with PTNS. Episodes of urinary frequency, leakage, urgency, and nocturia; number of follow-up visits; and medications were recorded. The mean quarterly drug, physician, nurse, and provider costs were calculated. The episodes of urinary symptoms, numbers of follow-up visits, and costs of medications and visits before and after PTNS were compared.Results:Of the 60 patients with refractory OAB, 24 patients who completed 12 weekly sessions of initial PTNS were evaluated. The number of urinary symptoms and follow-up visits significantly decreased after PTNS (p<0.05). The average quarterly medication cost decreased from $656.36±292.45 to $375.51±331.79 after PTNS (p=0.001). After PTNS, quarterly physician and nurse visit costs decreased from $81.73±70.39 to $25.89±54.40 and from $55.23±38.32 to $15.53±19.58, respectively (p<0.05). The quarterly total provider cost was similar before and after PTNS.Conclusion:PTNS treatment significantly improved urinary symptoms of patients with refractory OAB and reduced the costs of medications and physician and nurse visits.
Highlights
Overactive bladder (OAB) syndrome is defined as "urgency, with or without urge incontinence, usually with frequency and nocturia in the absence of proven infection or other obvious pathology" by the International Continence Society [1]
The results of our study showed that urinary symptoms were improved and the costs of medications and physician and nurse visits were reduced significantly in patients with refractory OAB who were treated with Percutaneous tibial nerve stimulation (PTNS)
Congregado Ruiz et al [10] showed that leakage and daytime and nighttime frequency episodes were significantly improved after PTNS treatment [10]. van Balken et al [11] found a positive response with PTNS therapy in terms of leakage episodes, voiding frequency, and nocturia
Summary
Overactive bladder (OAB) syndrome is defined as "urgency, with or without urge incontinence, usually with frequency and nocturia in the absence of proven infection or other obvious pathology" by the International Continence Society [1]. The prevalence of OAB varies between 12.8% and 17.4% and increases with age for both sexes [2,3]. In the United States (US), its prevalence is 16.0% in men and 16.9% in women, and 29.8 million adults aged ≥40 years are estimated to have OAB symptoms [4,5]. The American Urological Association and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction suggest that the first-line treatment should be composed of diet and behavioral therapies such as reducing caffeine, alcohol, and fluid intake; weight loss; pelvic floor physical therapy; timed voiding; and bladder training. Antimuscarinic therapies may be added to behavioral therapies at the same time. Second-line treatment should include pharmacologic agents, antimuscarinics or oral β3adrenoceptor agonists for a minimum of 3 months. Adverse effects of medication or inadequate symptom relief may lead
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