Real-world Compliance With Percutaneous Tibial Nerve Stimulation Maintenance Therapy in an American Population

Published:February 10, 2021DOI:



      To evaluate percutaneous tibial nerve stimulation (PTNS) maintenance therapy dropout rates and identify factors associated with compliance in an American population.


      We retrospectively queried our PTNS database for patients from 2014-2019. Demographic, relevant clinical, and visit data were collected. Maintenance therapy was patient-driven and frequency of sessions was tapered based on symptomology. Upon completion of 12 initial sessions, we assessed dropout from maintenance at 3, 6, 9, and 12 months. Multiple variables were tested for correlation with dropout in patients continuing maintenance therapy for 1 year vs those who dropped out.


      One hundred and sixty-three PTNS patients were identified, of which 104 completed initial therapy and 81 proceeded with maintenance therapy. At 3, 6, 9, and 12 months, maintenance continuation rates were 77.8% (63/81), 58.0% (47/81), 45.6% (37/81), and 39.5% (32/41), respectively. Primary reasons for dropout were worsening of urinary symptoms/lack of efficacy (n = 21), time commitment (n = 9), loss of insurance (n = 5), medical comorbidities (n = 4), request for alternative OAB treatment (n = 2), and unknown (n = 8). On both univariate and multivariate analysis, perceived symptom improvement (P<.01; HR = 0.02, P< .01) was associated with continuing maintenance therapy. On only univariate analysis, neurological history (P = .02) and multiple sclerosis history (0.02) were associated with continuing therapy.


      Only 39.5% of patients continue to undergo maintenance PTNS therapy after 1 year. Future studies are required to understand and ameliorate factors for low compliance in PTNS maintenance therapy.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stewart WF
        • Van Rooyen JB
        • Cundiff GW
        • et al.
        Prevalence and burden of overactive bladder in the United States.
        World J Urol. 2003; 20: 327-336
        • Gormley EA
        • Lightner DJ
        • Faraday M
        • Vasavada SP
        American Urological A, Society of Urodynamics FPM. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment.
        J Urol. 2015; 193: 1572-1580
        • Burton C
        • Sajja A
        • Latthe PM.
        Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis.
        Neurourol Urodyn. 2012; 31: 1206-1216
        • Peters KM
        • Carrico DJ
        • Perez-Marrero RA
        • et al.
        Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial.
        J Urol. 2010; 183: 1438-1443
        • Moossdorff-Steinhauser HF
        • Berghmans B.
        Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: a systematic review.
        Neurourol and Urodyn. 2013; 32: 206-214
        • Gaziev G
        • Topazio L
        • Iacovelli V
        • et al.
        Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review.
        BMC Urol. 2013; 13: 61
        • Salatzki J
        • Liechti MD
        • Spanudakis E
        • et al.
        Factors influencing return for maintenance treatment with percutaneous tibial nerve stimulation for the management of the overactive bladder.
        BJU Int. 2019; 123: E20-e28
        • Sirls ER
        • Killinger KA
        • Boura JA
        • Peters KM.
        Percutaneous tibial nerve stimulation in the office setting: real-world experience of over 100 patients.
        Urology. 2018; 113: 34-39
        • Peters KM
        • Carrico DJ
        • Wooldridge LS
        • Miller CJ
        • MacDiarmid SA.
        Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study.
        J Urol. 2013; 189: 2194-2201
        • Kim TH
        • You HW
        • Park JH
        • et al.
        Persistence of solifenacin therapy in patients with overactive bladder in the clinical setting: a prospective, multicenter, observational study.
        Int J clin practice. 2016; 70: 351-357
        • Lawrence M
        • Guay DR
        • Benson SR
        • Anderson MJ.
        Immediate-release oxybutynin versus tolterodine in detrusor overactivity: a population analysis.
        Pharmacotherapy. 2000; 20: 470-475
        • van der Pal F
        • van Balken MR
        • Heesakkers JP
        • Debruyne FM
        • Bemelmans BL.
        Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary?.
        BJU Int. 2006; 97: 547-550
        • Tam J
        • Nguyen A
        • Du C
        • et al.
        PD32-06 patients have poor compliance with repeat onabotulinumtoxin a injections for overactive bladder.
        J Urol. 2018; 199: e646-e647
        • Rahnama'i MS
        • Marcelissen TAT
        • Brierley B
        • Schurch B
        • de Vries P
        Long-term compliance and results of intravesical botulinum toxin A injections in male patients.
        Neurourol Urodyn. 2017; 36: 1855-1859
        • Seth JH
        • Gonzales G
        • Haslam C
        • et al.
        Feasibility of using a novel non-invasive ambulatory tibial nerve stimulation device for the home-based treatment of overactive bladder symptoms.
        Transl Androl Urol. 2018; 7: 912-919
        • Heesakkers J
        • Digesu GA
        • van Breda J
        • Van Kerrebroeck P
        • Elneil S.
        A novel leadless, miniature implantable Tibial Nerve Neuromodulation System for the management of overactive bladder complaints.
        Neurourol Urodyn. 2018; 37: 1060-1067
        • Te Dorsthorst MJ
        • Heesakkers J
        • van Balken MR
        Long-term real-life adherence of percutaneous tibial nerve stimulation in over 400 patients.
        Neurourol Urodyn. 2020; 39: 702-706