One-Year Transcutaneous Tibial Nerve Stimulation Treatment Persistence in Lower Urinary Tract Dysfunction: Clinical...

To assess 1-year Transcutaneous Tibial Nerve Stimulation (TTNS) treatment persistence in routine clinical care and to explore clinical and urodynamic factors associated with treatment persistence in patients with lower urinary tract dysfunction (LUTD).

A prospective, monocentric, observational cohort study was conducted between October 2022 and January 2024 (RnIPH 2022-109). Adult patients with LUTD for whom TTNS was prescribed and initiated at home (20 min/day) were consecutively included. Baseline assessment included clinical characteristics, urodynamic findings, and patient-reported outcomes, including the Patient Global Impression of Severity (PGI-S), Patient Global Impression of Improvement (PGI-I), Urinary Symptom Profile (USP), and QUALIVEEN-Short Form (QSF). Treatment persistence and patient-reported outcomes were assessed at 2-4 months, and persistence was reassessed at 12 months. Persistence over time was described using a Kaplan-Meier analysis, and factors associated with time to discontinuation were explored using Cox proportional hazards models.

Fifty-six patients initiated TTNS, including 32 (57%) with neurological LUTD. At 1 year, 21/56 patients (38%) remained persistent, including 21/34 (62%) among the device purchasers. Persistence was higher in neurological (56%, 18/32) than in non-neurological patients (13%, 3/24), and neurological etiology was associated with a lower hazard of discontinuation in multivariable Cox analysis (adjusted HR: 0.42, 95% CI: 0.18-0.99, p = 0.047). Lower symptom burden and greater perceived improvement at 2-4 months were associated with both device acquisition and long-term persistence, particularly through lower PGI-S, PGI-I, USP-OAB, and QSF scores. Overactive urethral sphincter was more frequent in neurological patients (p = 0.008) and among persistent purchasers (p = 0.006). TTNS was well tolerated, with only one minor adverse event reported.

TTNS treatment persistence in routine care appeared to depend on both clinical profile and early patient-reported outcomes. The 2-4-month reassessment emerged as a key decision point for evaluating long-term TTNS treatment persistence. These findings support further investigation into the relationship between neuro-urological phenotypes and long-term TTNS treatment persistence.