Bladder trial

Gaspard L, Tombal B, Opsomer RJ, Castille Y, Van Pesch V, Detrembleur C.[Physiotherapy and neurogenic lower urinary tract dysfunction in multiple sclerosis patients: A randomized controlled trial]. Prog Urol. 2014; 24(:697-707.

AIM: This randomized controlled trial compare the efficacy of pelvic floor muscle training vs. transcutaneous posterior tibial nerve stimulation.
PATIENTS AND METHODS:Inclusion criteria were EDSS score<7 and presence of lower urinary tract symptoms. The primary outcome was quality of life questionnaire. Secondary outcomes included overactive bladder questionnaire and frequency of urgency episodes Sample size was calculated after 18 patients were included. Data analysis was blinded. Each patient received 9 sessions of 30minutes weekly. Patients were randomized in pelvic floor muscles exercises with biofeedback group (muscle endurance and relaxation) or transcutaneous posterior tibial nerve stimulation group (rectangular alternative biphasic current with low frequency).
RESULTS:A total of 31 patients were included. No difference appeared between groups for quality of life, overactive bladder and frequency of urgency episodes (respectively P=0.197, P=0.532 et P=0.788). These parameters were significantly improved in pelvic floor muscle training group (n=16) (respectively P=0.004, P=0.002 et P=0.006) and in transcutaneous posterior tibial nerve stimulation group (n=15) (respectively P=0.001, P=0.001 et P=0.031).
CONCLUSIONS:Pelvic floor muscle training and transcutaneous posterior tibial nerve stimulation improved in the same way symptoms related to urgency in MS patients with mild disability.

Percutaneous tibial nerve stimulation (PTNS), also referred to as posterior tibial nerve stimulation, is used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency, urinary frequency and urge incontinence.

PTNS can be used as a primary therapy. However, treatment for an overactive bladder is initially conservative followed by drugs. As pelvic floor training improves symptoms this should be attempted as a first-step, particularly in women who have had children.

During the PTNS procedure, the patient sits comfortably with the treatment leg elevated. A fine needle electrode is inserted into the lower, inner aspect of the leg. As the goal is to send stimulation through the tibial nerve, it is important to have the needle electrode near (but not on) the tibial nerve. A surface electrode (grounding pad) is placed on the same leg. The needle electrode is then connected to an pulse generator which delivers an adjustable electrial pulse that travels to the sacral plexus in the spine via the tibial nerve. Among other functions, the sacral nerve plexus regulates bladder and pelvic floor function.

PTNS has very few side effects: tingling/mild discomfort around the ankle, mild redness/inflammation around the ankle, numb toes & mild stomach ache.

NB: PTNS is available on the NHS.

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Neuro Doc Gnanapavan

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