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    PTNS for overactive bladder: Patient selection and technique

    In-office treatment offers noninvasive alternative for patients with refractory OAB

    Scott MacDiarmid, MDScott MacDiarmid, MD Christopher M. Gonzalez, MD, MBASeries Editor Christopher M. Gonzalez, MD, MBA

    Dr. MacDiarmid is director of the Alliance Urology Specialists Bladder Control and Pelvic Pain Center in Greensboro, NC. He is a consultant/speaker for Uroplasty, Allergan, and Medtronic. Dr. Gonzalez is professor of urology at Northwestern University’s ­Feinberg School of Medicine, Chicago.

    The primary treatment of overactive bladder (OAB) is behavioral modification and medication with the goal of relieving symptoms and balancing drug treatment efficacy with side effects and costs. Unfortunately, many patients do not reach their treatment goal with conservative therapy and suffer from a new disease that in day-to-day practice is seldom talked about by patients and health care providers. This disease is called “refractory OAB,” or what I have termed “ROAB.” 

    ALSO READ: Anticholinergic cycling not effective in OAB with UI

    This article provides a real-world definition of ROAB and its prevalence, then examines treatment options, with a focus on percutaneous tibial nerve stimulation as a noninvasive form of neuromodulation “for the masses.”

    Who has ‘ROAB’?

    How many patients have ROAB? Simply stated, millions do! In fact, ROAB is much more prevalent than OAB that is currently effectively managed by medical therapy. Let’s face it, more than 50% of OAB patients who are treated for their condition do not respond favorably to or reach their treatment goal with medication (Int J Clin Pract 2011; 65:567-85).

    A 2012 AUA/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) guideline panel defines the refractory OAB patient as one who has failed appropriate behavioral therapy of sufficient length and a trial of at least one antimuscarinic medication administered for 6 to 12 weeks (J Urol 2012; 188:2455-63).

    A more real-world definition of ROAB includes those patients who:

    • do not respond to medication in spite of trying multiple agents
    • cannot tolerate medication
    • cannot afford medication
    • have a contraindication to taking medication
    • do not want to take medication.

    Patients with ROAB are those who keep coming back after cycling through various agents and are still symptomatic. They are those who do not respond to their 2 weeks of samples and who simply give up, thinking they cannot be helped and unfortunately surrender to their condition. In addition, think about the millions of men and women with OAB symptoms who are only partially satisfied with their antimuscarinic agent, alpha-blocker, or beta-3 agonist and who would jump at the chance of achieving better symptom relief by adding a noninvasive treatment to their current medical therapy.

    Next - Under-treatment: Scope of problem

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    Scott MacDiarmid, MD
    Dr. MacDiarmid is Associate Professor, Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC. He serves as ...

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