Successful Therapy of Overactive Bladder Syndrome with Percutaneous Tibial Nerve Stimulation: A Case Report

Abstract

Introduction: Overactive bladder syndrome is defined as urgency with or without incontinence, often with frequency and nocturia but without infection or other pathology. For the patient, overactive bladder syndrome means an essential loss of quality of life. The therapeutic concept follows a graduated, stepwise scheme. The first step consists of behavioral treatment with bladder training and pelvic floor education as well as local estrogen therapy. Following inadequate response to these measures, it is often necessary to add anti-muscarinic drugs or beta-3 agonists. In case of medical contraindication or insufficient response to pharmacologic treatment, neuromodulation, i.e. percutaneous posterior tibial nerve stimulation, should be routinely offered to overactive bladder syndrome patients. Case Report: We present the case of an 81-year-old woman with long-lasting overactive bladder syndrome without incontinence. Behavioural treatment, local estrogen and anti-muscarinic therapy were unsatisfactory, therefore, an additional treatment employing percutaneous posterior tibial nerve stimulation was implemented. Under this regimen, the symptoms dramatically improved. Conclusion: The reported overall success rate of percutaneous posterior tibial nerve stimulation in the literature ranges from 33 - 71%, with success being defined as more than a 50% decrease in urgency and a 25% reduction of frequency and nocturia, respectively. There is no other therapeutic option for overactive bladder syndrome patients, that reaches similar success rates. Percutaneous posterior tibial nerve stimulation should be routinely offered to overactive bladder syndrome patients and employed as an early step in the treatment of overactive bladder syndrome, sometimes in combination with or even before the introduction of medications.