Posterior tibial nerve stimulation (PTNS) is a treatment option for symptomatic overactive bladder (OAB) approved by EAU and recommended by NICE but only after a multi-disciplinary team review for patients who have failed non-surgical management and are unwilling to have Botox or sacral neuromodulation. There is no standard protocol suggested by either, although NICE does mention that the initial treatment usually comprises twelve weekly sessions. There is clearly a need for a standard approach.

We present a critical evaluation of our current PTNS practice for OAB with a focus on standardisation and assessment of treatment efficacy.

A retrospective analysis was conducted using electronic patient records from a single NHS trust between January 2022 and July 2024. Data collected included patient demographics, recorded prior treatments, and duration of induction sessions.

37 patients (65% women) with mean age 61.2 years were included. 21.6% reported incontinence prior to PTNS whilst the remainder were dry. There was documented evidence of prior conservative treatment, completed bladder diary and pre-treatment ICIQ questionnaires for only 27.0%, 75.7% and 54% of patients respectively.

Induction treatment duration ranged from 3-20 weeks, with just 43.2% patients completing the NICE-recommended 12 weeks. Overall, 59.5% patients experienced subjective (patient-reported) or objective (based on post-induction ICIQ) symptomatic improvement after induction therapy. Higher response rates were observed in patients with  ≥ 12 weeks induction (81% vs 43%), OAB dry status (69% vs 25%) and female gender (62% vs 54%). Post-induction documentation of bladder diaries and ICIQ questionnaires was completed in less than 25% of cases. Frequency of maintenance sessions varied from once a fortnight to once every 3 months.

Although limited by a small sample size, trends suggest improved outcomes in patients undergoing at least 12 weeks induction therapy, in those with OAB dry symptoms and among females. This is represented in the attached figure. Additionally, the significant variability in documentation and treatment protocol indicates a lack of standardisation in practice.

Poor quality of documentation and lack of standardisation in practice seen at our Trust may be a more wide-spread phenomenon. Our findings underscore the urgent need for a wider survey of prevalent practice with a view to establish a professionally approved standard protocol for PTNS in OAB management. This could be followed by a larger prospective audit to validate these preliminary observations and enhance patient outcomes.