Percutaneous Tibial Nerve Stimulation for Neurogenic Detrusor Overactivity after Spinal Cord Injury: A Case Report

Abstract

Introduction: Neurogenic detrusor overactivity (NDO) is characterized by spontaneous or provoked involuntary detrusor contractions during the storage phase in urodynamic investigation secondary to neuro-urological disorders. Percutaneous tibial nerve stimulation is a minimally invasive neuromodulation technique for treating overactive bladder symptoms. Case: We report the case of a 53-year-old male, who came with DO secondary to spinal cord injury (SCI) since November, 2023. The patient had an inadequate response to oral anticholinergic drugs (tolterodine, propiverine and solifenacin). Therefore, the patient adopted weekly percutaneous tibial nerve stimulation (PTNS) and continued anticholinergic therapy with clean intermittent catheterization (CIC). At 3 months,12 months and 18 months from baseline, urodynamic assessments indicated normalized bladder compliance. At 3 months from baseline, the patient had no incidence of DO and complete dryness. Significant changes were already present in Incontinence-Specific-Quality-of-Life Instrument (59 vs 19) and mean voiding volume (400 ml vs. 70 ml), respectively. The outcomes had still yielded significant improvements until 18 months from baseline. Besides, the patient reported no related adverse event. Conclusion: PTNS was effective and safe as the treatment for NDO secondary to SCI.