Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
YC Kam, PY Hui, PC Chan, HC To
Affiliation :
Urology nurse clinic, Department of Surgery
Queen Elizabeth Hospital, Hong Kong
Introduction :
Overactive bladder (OAB) syndrome is urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection. It is a common urological condition with significant psychosocial implications. Symptoms decrease quality of life (QoL), increase social isolation and result in increased morbidity. Population-based studies have reported prevalence rates ranging from 16.6% to 24.7%. OAB patients struggle with the chronic condition requiring long-term treatment to maintain symptom suppression. 1st line & 2nd line treatments to OAB include behavioural modifications/pelvic floor muscle training and/or antimuscarinics, however it is about 40 % of OAB population failed to response whether or not this is related to inefficacy or intolerable adverse events. These refractory OAB patients may require escalation to third-line surgical treatments such as intravesical botulinum toxin-A injections, sacral neuromodulation, augmentation cystoplasty and in refractory cases urinary diversion. However, most refractory OAB patients hesitate and remain “untreated” after discussion about the surgical approach. This innovative nurse-led therapeutic approach, PTNS provides patients with a brand new minimal invasive treatment option in between conservative and surgical treatment options. It’s a breakthrough of the role of Urology specialty nurses to carry out therapeutic treatment and provide direct care to patients with effective treatment outcomes. PTNS is a peripheral neuromodulation technique, in which the nervus tibialis (L4-S3) is electrically stimulated above the inner ankle. The therapy received US FDA approval in 2000 as an office therapy for treating OAB.
Objectives :
To investigate the efficacy of Percutaneous Tibial Nerve Stimulation (PTNS) treatment on patients who were referred to Urology Nurse Clinic in the management of overactive bladder (OAB) with pharmacological regimens has failed.
Methodology :
All overactive bladder patients who were referred to the Urology Nurse Clinic for PTNS from Jan 2019 to Dec 2021 were retrospectively reviewed. The baseline demographic data, age & sex, whether patients had previous bladder training (BT) and if patients were taking anticholinergic or beta-3 adrenergic agonists were noted down. At the 1st, 4th, 8th and 12th treatment the patients were assessed by their symptoms progression, bladder diary, urgency incontinence (UUI) episodes, nocturia and day frequency. Patients’ subjective improvement on OAB, frequency, urgency & nocturia were also assessed. The post PTNS complications were also reviewed.
Result & Outcome :
There were 17 patients included for analysis with mean age of 64 years old (9 Male & 8 Female). 88.2% patients had bladder training previously. 64.7% patients are taking anticholinergic or beta-3 adrenergic agonists. After 12 weeks of PTNS treatments, the UUI episodes of these patients decreased from 7 times/week to 1 time/week (p=0.001), Nocturia episodes decreased from 3 times/ night to 1.5/ night (p=0.001), day frequency decreased from 11 times/ day to 6.5 times/day (p=0.002), maximum voided volume decreased from 220ml/ void to 250ml/void (p=0.068). Patients’ subjective improvement on OAB, frequency, urgency & nocturia are 45%, 35%, 45% and 50% respectively. 0.06% patient reported skin itchiness with tegaderm reported as complication.
PTNS treatment done by Urology Nurses is effective to all patients of OAB. It can effectively decrease the UUI episodes, nocturia and day frequency and improved the quality of life of OAB patients. It provides option for patients who failed with pharmacological regimens and do not prefer invasive procedure such as sacral neuromodulation. From this study, the efficacy is shown starting from 8-week treatment onwards. For those non-respondents after 8-week treatment, termination of treatment can be considered if no subjective improvement is reported in order to save some resources.
