Predictors of Progression to Alternate Minimally Invasive Therapies for Overactive Bladder Following Percutaneous Tibial Nerve Stimulation (PTNS)

Background/Objectives: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive intervention for overactive bladder (OAB) typically utilized in patients for whom behavioural and pharmacological therapies do not work. The aim of this study is to identify predictors of progression to alternate minimally invasive treatment options following PTNS in patients with OAB refractory to medical and behavioural therapy. In addition, the aim of this study is to determine predictors of maintenance therapy after completing PTNS induction. Methods: This study is a retrospective cohort analysis of patients that underwent PTNS between March 2018 and June 2023 for management of overactive bladder. The primary outcome of this study is progression to alternate minimally invasive treatment options following PTNS, such as sacral neuromodulation or intradetrusor onabotulinum toxin injections. The secondary outcome of this study is the continuation of maintenance therapy following the initial 12-week PTNS treatment course. Results: A total of 49 patients were included for analysis. Overall, 33% (16/49) of patients had further alternate minimally invasive treatment. Multivariate logistic regression analysis identified only age (OR = 1.06; p = 0.05) as a significant predictor of progression to alternate minimally invasive OAB treatment following PTNS. Overall, 27 (55%) patients continued with ongoing monthly maintenance PTNS after completing initial weekly treatment for OAB. Multivariate logistic regression only identified sex as a predictor of ongoing maintenance PTNS (OR = 13.2; p = 0.017). Conclusions: The present study identifies younger age as a significant predictor of progression to further minimally invasive OAB treatments after PTNS. Furthermore, female sex was found to be a significant predictor of ongoing maintenance PTNS.