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Beyond urotherapy: Posterior Tibial Nerve Stimulation (PTNS) for pediatric refractory overactive bladder
Adriana Messina, Master of Science in Nursing, Amanda Berry, Doctorate in Nursing, Katherine Fischer, Doctorate of Medicine, Danielle Kaiser, Master of Science in Nursing, Keely McClatchy, Master of Science in Nursing, Laura Slonaker, Master of Science in Nursing, Jason VanBatavia, Doctorate of Medicine.
Childrens Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Overactive bladder affects up to 12% of children from 5-10 years old and 0.5% of adolescents from age 16-18, significantly impacting quality of life. Posterior tibial nerve stimulation (PTNS) has become more prevalent in pediatric patients who suffer from refractory overactive bladder. PTNS is considered minimally invasive with little to no side effects. This has influenced families to consider PTNS as a viable treatment option to improve OAB symptoms. METHODS:A retrospective chart review was conducted including patients with refractory OAB who underwent PTNS from 2021 to the present. Patients were set up for 12 weekly 30 minute sessions. Some patients with lingering symptoms at the 12
th session proceeded to biweekly or monthly maintenance therapy. Refractory overactive bladder was defined as failure to improve despite a 3-month trial of urotherapy, failed medication trial of at least 4 weeks or had experienced medication side effects or contraindications. Quantitative outcomes were assessed using the Vancouver Symptoms Score (VSS) and the Pediatric Incontinence Questionnaire (PinQ). Scores were compared at baseline, at 12 weeks of PTNS treatment and at final or maintenance follow-up. Exclusion criteria included with history of neurogenic bladder, anatomic abnormalities that could contribute to lower urinary tract symptoms, neuropathy or bleeding disorders.RESULTS:Thirty-five patients, median age 11.3 years (IQR 10.3015.0) met inclusion criteria. Two patients did not complete the full 12-week PTNS treatments with each finishing 10 and 11 sessions respectively. Scores were analyzed from this final session and reported as the final and 12
th session. Urinary incontinence with either urgency, frequency or both was present in 27/35, (77%) of patients, and 30/35,(86%) had accompanying nocturnal enuresis. Neurodevelopmental or mental health disorders were present in 22/35 (63%) of patients.Median VSS improved from 18 (IQR 14-23.5) at baseline to 13 (IQR 10-17) at 12 weeks of PTNS and to 12 (IQR 9-15.5) at final or maintenance follow-up. Median PinQ scores improved from 34 (IQR 16-42.5) at baseline to 17 (IQR 8.5-35) at 12 weeks and 16.5 (IQR 6.75-29.5) at final or maintenance follow up. Improvements in both VSS and PinQ scores from baseline to 12 weeks and final or maintenance follow-up were statistically significant (p< 0.01). Subjective improvement was reported by 27/35, (77%) of patients at the 12
th PTNS visit. Changes in individual symptom scores for incontinence and urgency were analyzed (Table 1). Both symptoms showed statistically significant improvement at 12 weeks and at the final visit.CONCLUSIONS:PTNS was associated with significant improvements in urinary symptoms and quality of life for pediatric patients with refractory OAB. These findings support PTNS as an effective, minimally invasive and safe treatment option for children and adolescents in reducing OAB symptoms.
Changes in Vancouver OAB symptom scores during PTNS treatment| Vancouver Symptom Score Item | Median Item Score (IQR)Baseline | Median Item Score (IQR)12 weeks | Median Item Score (IQR)Final | P-value12 weeks | P-valueFinal |
| #1 Incontinence: I pee in my underwear during the day | 2 (1-3.5) | 2 (0-3) | 1 (0-2.5) | p< 0.03 | P< 0.01 |
| # 4 Urgency: I feel that I have to rush to the bathroom to pee | 3 (1-4) | 1 (0-1) | 1 (0-1.25) | p< 0.001 | P< 0.001 |
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