Abstract General Information

Title

POSTERIOR TIBIAL NERVE STIMULATION FOR REFRACTORY OVERACTIVE BLADDER IN PEDIATRICS: SYMPTOM SCORE AND QUALITY OF LIFE IMPROVEMENT

Introduction and objective

Despite appropriate treatment of lower urinary tract symptoms (LUTS) with urotherapy, biofeedback, and medications, many children will have persistent symptoms. For adults with refractory symptoms, guidelines recommend neuromodulation as next step, however, use in pediatrics is less defined. Our objective was to review our experience with posterior tibial nerve stimulation (PTNS) in children and adolescents for refractory non-neurogenic overactive bladder (OAB).

Method

Since April 2022 we have been prospectively following all patients treated with PTNS for refractory non-neurogneic OAB. Criteria were: failed urotherapy and at least one antimuscarinic or beta-3 agonist. Failure was defined as <50% improvement in incontinent episodes on diaries and persistent LUT symptom score (DVISS) >11 points. Constipation was treated prior to PTNS. Induction of PTNS was 12 weekly 30-minute sessions in the office with 34 gauge needle. After induction, patients may continue to receive PTNS every other week for 6 months then monthly for up to 2 years. All patients fill out weekly questionnaires (DVISS, pediatric incontinence quality of life [PinQ]). All patients who underwent at least 12 sessions were included.

Results

9 patients started PTNS at median age 16.5 years (range 9-18). Median DVISS score at start of PTNS was 24 (IQR 14-26) and decreased significantly to 11 after 12 weeks of PTNS (Wilcoxon test, p<0.01). At last follow up (median 18 PTNS sessions) DVISS score decreased to 10 (IQR 9-11.5; p<0.01). Four of 9 patients had a decrease in DVISS score by the 6th PTNS session, 6 of 9 patients had a decrease in DVISS score by 12th session and 7 of 9 (77%) had decrease by last follow up visit. Median PinQ scores also decreased significantly from initial score of 42 to 9 at final follow up (p<0.01).

Conclusion

The majority of children with refractory OAB will have objective improvements in symptom score and QoL after induction of PTNS and these benefits persist during maintenance PTNS. Patients should be made aware that improvement may take longer than 6 weeks and that some patients continue to improve after the first 12 weeks of PTNS.

Area

Bladder Bowel Dysfunction