Introduction and Objectives: The prevalence of overactive bladder symptoms (OAB) has been described as high as 42% in some studies for patients over 75 years of age. Percutaneous tibial nerve stimulation (PTNS) has been utilized for treatment of OAB. No studies have evaluated its efficacy in the elderly. Our main objective is to evaluate the efficacy of PTNS in octogenarians.
Methods: At Cleveland Clinic from 2010 through 2012 patient data was collected in a prospective manner in a single staff member’s clinic (HBG). After IRB approval, patients were identified for retrospective analysis by CPT codes 64566/64999. Exclusion criteria included patients who did not receive PTNS treatment or did not have OAB symptoms. Patient demographics included BMI, cystoscopic and urodynamic evaluation, prior incontinence surgeries and treatment. Daytime frequency was standardized as patient reported voids over a 16 hour period. Patient success was defined by improvement after a standard 12 week course of PTNS, continuation of maintenance therapy or subjective improvement on IIQ-7/UDI-6 questionnaire scoring. Statistical analysis was performed using Fisher’s exact and Mann Whitney tests.
Results: A total of 50 charts were reviewed for this study. 31 patients met inclusion criteria. 12 patients were 80 years or older (mean 84 years ± 4.5) at PTNS treatment. The octogenarian group’s symptoms included a median daytime frequency of 10 voids (range 5-16) and median nocturia of four voids (range 1-6). 8/12 patients underwent urodynamic evaluation and of these, 3/8 patients (37.5%) had detrusor overactivity. Patient comorbid status was characterized using BMI (median 27.8 kg/m 2 ± 5.7) and median age-adjusted Charlson Comorbidity Index (CCI) (median 7 ± 1.1). 50% of octogenarians demonstrated improvement over a 12 week period of PTNS. BMI was the only significant difference between responders and non responders (24.2 vs. 32.8 kg/m 2 p=0.015). The significant difference between the octogenarian and an under 80 years of age cohort was CCI (median 7 vs. 3 p<0.05). Response to treatment was not statistically different among octogenarians vs. the younger cohort (50% vs 63% p=0.7).
Conclusions: To our knowledge this is this first study to evaluate the efficacy of PTNS in octogenarians. PTNS can be used effectively in elderly patients with refractory OAB symptoms. Further studies will be needed to evaluate prognostic indicators for effectiveness of PTNS in this population.