Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis

Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure.Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Overactive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration

Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis

Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure. Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms

URODYNAMICS UTILITY PATTERN AMONG INDONESIAN UROLOGISTS

Objective: Aim of this study was to describe urodynamic utility pattern among Urologists in Indonesia especially in treating lower urinary tract symptoms (LUTS), urinary retention, overactive bladder (OAB), stress urinary incontinence (SUI) and urologic pediatric cases. Materials & methods: Subjects were Indonesian Urologists who attended urological scientific meetings or workshop in Jakarta between February-July2014. They were given questionnaires about urodynamics and its indications. Results: One hundred and eight Urologists completed and returned the questionnaires out of 303 Urologists in Indonesia. Thirty eight Urologists worked at hospitals where urodynamic machine is available, the rest sent their urodynamic cases elsewhere. Most of Urologists ordered urodynamics for LUTS patients with neurological deficit (84.3%) and weak anal sphincter tone/bulbocavernosus reflex (62.0%). In OAB cases, urodynamics was used in cases with failure of medical therapy (70.4%) and neurological deficit (68.5%). Two most common indication criterias in SUI cases were failure of conservative therapy (70.4%) and mixed incontinence cases (SUI with OAB) (60.2%). Neurological deficit (66.7%) and urinary incontinence (26.9%) were the most frequent urodynamic indications applied in children. Conclusion: We described the urodynamic utility pattern among Indonesian Urologists. Availability of urodynamic machine, patient economic capabilities, guideline availability on urodynamics could be the factors affecting this pattern