Disclosures: Argyrios Stampas, MD: Nothing to disclose

Objective: Tibial nerve stimulation is used to decrease incontinence in overactive bladder (OAB) in the clinic setting. In the first home pilot trial in chronic spinal cord injury (SCI), we investigate whether transcutaneous tibial nerve stimulation (TTNS) is feasible and can be performed safely at home, while maintaining or improving bladder continence and quality of life (QOL).

Design: 4-week observational trial.

Setting: Recruited from SCI clinic and intervention performed at home.

Participants: Adults with chronic SCI with neurologic level T9 or above performing intermittent catheterization on stable dose of ≤ 2 OAB medications.

Interventions: TTNS demonstrated in clinic using NMES device and provided for daily home use with instructions and voiding diary. After completing the first week of TTNS, participants instructed to reduce their OAB medications weekly.

Main Outcome Measures: The primary outcomes were safety, compliance, and satisfaction with home TTNS. Secondary outcomes included post-trial incontinence QOL (I-QOL) survey, anticholinergic side effect questionnaire, and changes in catheterization frequency and volumes, incontinence episodes, and OAB medication use.

Results: All 16 subjects who started the study completed the 4-week trial without complications and high satisfaction with TTNS. Fourteen of the 16 participants were using OAB medications, and 12 (86%) reduced their medication while maintaining stable bladder catheterization values and incontinence episodes. OAB medication reduced by approximately 3.2 mg weekly (95%CI -5.9, -0.4) over the 4 weeks and anticholinergic side effects decreased from baseline. At 4 weeks, I-QOL scores improved compared to baseline in all domains.

Conclusions: This pilot trial suggests TTNS is feasible and safe to be performed at home in people with chronic SCI. Reductions in OAB medications were possible with subsequently decreased side effects while maintaining similar bladder programs, continence, and improved QOL. Larger studies with long-term outcomes and urodynamic measures are needed to establish home TTNS as an option for bladder management in SCI.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/can-ttns-be-a-standard-neurogenic-bladder-management-strategy-in-spinal-cord-injury/