Use of transcutaneous posterior tibial neurostimulation(T-PTNs) in chilean patients: Could a home-based supervised treatment option be more effective than an office-based model?

Abstract

Objective: Describe the use of transcutaneous posterior tibial neurostimulation (t-PTNS) with a transcutaneous electrical nerve stimulation device (TENS) in our population and evaluate the efficacy as a treatment for Overactive bladder (OAB). In addition, compare the efficacy of t-PTNS according to whether it was used previously, concomitantly and/or after anticholinergics. Methods: A retrospective study from a prospectively collected database between 2008-2018 was conducted. The inclusion criteria were female patients with indication and use of t-PTNS, with at least one evaluation after t-PTNS used.We used t-PTNS in 30 minute- sessions with 20 Hz and 200 milliseconds width stimulus (these settings are fixed on the machine). The patients receive the first session and then they are offered to acquire the TENS device to complete treatment at home or to complete the 36 sessions at the hospital 3 times a week. Usually when the patients do the sessions at home they do it daily. The primary endpoint was the efficacy of the treatment, according to a subjective evaluation of the patients. Treatment failure was defined as a null response to the therapy, after 36 sessions. The variables evaluated were: age, parity, type of parity, BMI, ISI score and use of other therapies for OAB. Results: 120 female patients with an average age of 66 ± 11.7 years were included. The average parity was 2.8 ± 1.4. Of the 120 patients, 36 (30%) performed t-PTNS alone, being anticholinergic naïve (Group 1), 37 (30.8%) used t-PTNS after failing anticholinergics (Group 2), and 47 (39.17%) used t- -PTNS concomitantly with anticholinergics (Group 3). Of all patients, 74.2% completed 36 sessions, 32 (26.7%) acquired the TENS device and 50% had a successful treatment. Success between groups was as follows: Group 1 had 58.3% success, Group 2 had 45.95% and Group 3 had 46.8%. Of the patients who acquired the TENS device, 23 (72%) were successful. After a logistic regression analysis, the fact of acquiring the TENS device was the only variable that persisted statistically significant as a protective factor for treatment failure, with an OR of 0.132 (CI 95% 0.038-0.455) Conclusions: The success rate was 50%. anticholinergic naïve group had a higher success rate, probably because in the other 2 groups, the patients with OAB more difficult to treat were more prevalent since they failed another therapy or needed combination of treatments. Another very relevant finding was that performing the t-PTNS at home was a predictive factor for success, probably related to a daily application of the t-PTNS and therefore a more continuous therapy instead of a 3-times a week model (70 vs 50% success). In our country, TENS devices cost US$60 (on amazon they are US$29), this figure is much less to any other OAB treatment option and could be used as an OTC therapy, because there are no side effects to it. This data could be used by providers to guide their patients in choosing the best treatment for their condition.