Hypothesis / aims of study
Most cases with Lower Urinary Tract Symptoms (LUTS) are diagnosed as non bacterial prostatitis, simple overactive bladder syndrome or psychogenic voiding dysfunction (1). Urodynamic study has enhanced awareness of other possible etiologies of chronic LUTS in young men. These include, primary bladder neck dysfunction, dysfunctional voiding, detrusor overactivity and detrusor underactivity (1). All clinical, as well as urodynamic data of mild degrees of LUTS are frequently overlapped and are not as defining as they presumed to be. Therefore, neither the National Institute for Health and Clinical Excellence’s guidelines on incontinence nor its guidance on male LUTS recommend seeking a definitive diagnosis before treatment regimens (2).
Several studies, demonstrated that Posterior Tibial Nerve Stimulation (PTNS) is safe and effective in control of lower urinary tract symptoms in cases of overactive bladder, painful bladder syndrome and incontinence (3)
The present study was carried out to study the proposed place of PTNS in the management of LUTS in young men.
Study design, materials and methods
With clear consent and discussion of posterior tibial nerve stimulation data and expectations, thirty cases were enrolled in the present study. These young men 18 to 39 years, with mean of 28.87 ± 5.72 years were complaining of persistent lower urinary tract symptoms more than six months, despite empirical treatment. Exclusion criteria include age less than 18 or more than 39 years, cases with diabetes mellites, neuro-psychiatric problems, urinary tract infection, urinary calculi, previous urological surgery or infra-vesicular obstruction.
All cases were subjected to thorough history evaluation, International Prostatic Symptom Score (IPSS), voiding diary, as well as, Global Response Assessment scale (GRA). Cases evaluation was carried out at the first meeting, after 6 weeks, as well as, at the end of sessions (week 13). PTNS was carried out to all subjects with 12 sessions (30 minutes each) with electric current level of 0.5 to 9 mA at 20 Htz according to personal sensory response (3).
Results
Two patients did not feel improvement till week 6 and discontinued the regimen (6.67%). So the study continues with 28 cases.
The mean IPSS decreased significantly from 13.36 ± 3.32 to 8.92 ± 1.99 after 6 weeks to 6.42 ± 1.84 after 12 weeks (p < 0.05). The mean diurnal frequency decreased significantly from 9.96 ± 1.73 to 6.39 ± 1.47 after 6 weeks to 4.92 ± 0.89 after 12 weeks (p < 0.05). As regards nocturia, it decreased statistically significant from 4.21 ± 1.23 to 1.93 ± 1.18 after 6 weeks (p < 0.05) to 1.21 ± 1.13 after 12 weeks (p < 0.05). Moreover, twenty two men out of 30 cases started the study (73.33%), reported good response at GRA after 6 weeks, raised to 83.33% ( twenty five men) after 12 weeks. Also, three cases reported excellent response (10%) from week 6 to the end of sessions.
Interpretation of results
In the present study, thirty young men with refractory bothering LUTS, with no solid diagnosis, were subjected, after clear consent to PTNS for twelve weeks. Twenty eight men out of thirty (93.33%) in the present study reported statistically improvement of voiding diaries, improving nocturia and decrease of IPSS after 6 and 12 weeks of follow up period. On the other hand, only two cases (6.67%) discontinued the regimen as they did not had improvement criteria till 6 weeks.