BACKGROUND: Posterior tibial nerve stimulation (PTNS) has been shown to be well tolerated and to effect symptomatic improvement in pediatric patients with refractory non-neurogenic overactive bladder (OAB). In our practice, we utilize PTNS for select pediatric patients with refractory lower urinary tract symptoms (LUTS) of neurogenic etiology as well. Here, we investigate whether PTNS therapy affects the incidence of urinary tract infection (UTI) in these populations.
METHODS: We prospectively followed all patients at our institution treated with PTNS for refractory LUTS beginning April 2022. Induction comprises 12 weekly 30-minute PTNS sessions in the office. Patients may then continue to receive maintenance PTNS every other week for 6 months followed by monthly for up to 2 years. Any reported constipation was treated prior to PTNS induction. All patients under age 21 who completed a 12-week PTNS induction were included in our analysis. UTI was defined as a culture-positive symptomatic infection that was treated with antibiotics, as reported by the family or identified on chart review.
RESULTS: 23 patients started PTNS at median age 14.9 years (IQR 11.0-16.8). 74% were female. Median follow up was 18.5 months (IQR 10.6 -21.0). 13 patients (57%) had a prior history of UTI and 8 patients (35%) had a UTI treated in the year preceding PTNS initiation. Of these 8 patients, only 4 patients (50%) had a recurrent UTI after beginning PTNS. A 5th patient was treated empirically for symptoms of afebrile dysuria without a culture collected. There were no de novo UTIs in the remainder our cohort.
CONCLUSIONS: In our small series, pediatric patients who completed PTNS induction at our institution had fewer subsequent culture-positive UTI episodes, including 50% resolution in patients who had a UTI in the year leading up to PTNS initiation. While UTI testing and treatment rates are certainly also influenced by improved recognition by families and providers of non-infectious etiologies of bladder symptoms, a reduction in antibiotic treatment courses is a benefit regardless. Additional studies on larger cohorts with long-term follow up are merited to determine if there is a true effect of PTNS therapy on UTI incidence in pediatric patients with refractory LUTS.
