Percutaneous posterior tibial nerve stimulation as an effective treatment of refractory lower urinary tract symptoms in patients with multiple sclerosis: preliminary data from a multicentre, prospective, open label trial

Background: Percutaneous tibial nerve stimulation (PTNS) has been proposed as a new, minimally invasive neuromodulation technique to treat lower urinary tract symptoms (LUTS). Objective: To evaluate efficacy, safety and impact on quality of life (QoL) of PTNS on patients with multiple sclerosis (MS) who have LUTS. Methods: 21 patients (5 men, 16 women) with MS and LUTS unresponsive to anticholinergics were treated with 12 sessions of PTNS. Assessment of LUTS was by validated, self-administered chart and questionnaires, testing the subjective and objective relevance of LUTS for patients and their impact on QoL before and after treatment; the mean post-micturition residual was assessed by trans-abdominal ultrasound scanning. Analysis was by intention to treat. Results: There was a significant reduction of daytime frequency (from 9 to 6, p=0.04), nocturia (from 3 to 1, p=0.002) and mean post-micturition residual (from 98 +/- 124 ml to 43 +/- 45 ml, p=0.02). The mean voided volume increased from 182 +/- 50 ml to 225 +/- 50 ml (p=0.003). Eighty-nine percent of patients reported a treatment satisfaction of 70%. Significant improvement in QoL was seen in most domains of the King's Health QoL questionnaire (p<0.05). No adverse events were reported. Conclusions: PTNS is an effective, safe and well-tolerated treatment for LUTS in patients with MS.