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19–22 APRIL, 2017, BARCELONA, SPAIN
08:21–08:24
S20-4 (PP)
TREATMENT FAILURE IN POSTERIOR TIBIAL NERVE
STIMULATION: RISK ASSESSMENT
M S ANSARI and Panakaj GAUR
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal
transplantation, Lucknow, INDIA
PURPOSE
Overactive bladder is the commonest voiding dysfunction in children with a prevalence of 10-15%.
The conventional treatments such as behavioral therapy and anticholinergics fail in 20-30% of the
patients warranting alternative therapies like neuromodulation [posterior tibial nerve stimulation
(PTNS) and sacral implant]. The PTNS therapy has shown encouraging results but with a failure
rate of 30-40%. We intend to find out the risk factors for the failure of PTNS therapy.
MATERIAL AND METHODS
Thirty five patients with nonneurogenic overactive bladder underwent transcutaneous posterior tibial
nerve stimulation [TcPTNS]. Each patient underwent weekly session for 30 minutes for 12 weeks
followed by 3 weekly maintenance therapy. The parameters recorded were; overactive bladder
symptoms, number of voids daily (NV), maximum voided volume (MVV>or<60% of the expected
bladder capacity for age), urge incontinence (UI), urinary tract infection (UTI), hydroureteronephro-
sis (HUN), bedwetting (BW) and constipation. Response criteria were adopted from international
children continence society (ICCS) 2006.
RESULTS
Thirty five patients (median age 8.5+-5 yrs) received TcPTNS therapy. A total of 24 (68.6%) patients
reported improvement. Of these 15 (62.5%) patients reported cure and 9 (37.5%) patients reported
significant improvement of symptoms. Eleven (31.4%) patients failed to respond to Tc PTNS therapy.
On multivariate analysis the factors which adversely affected the success were MVV< 60% of the
expected bladder capacity for age (p value 0.040), UI (0.048) and HUN (0.010).
CONCLUSIONS
Smaller voided volume, urge incontinence and upper tract changes (HUN) are the risk factors for
the failure of TcPTNS therapy. These patients may be counseled early for alternative therapy.
08:24–08:36
Discussion