The Efficacy of Posterior Tibial Nerve Stimulation in the Treatment of Overactive Bladder in Patients with Multiple Sclerosis
Upon obtaining consent, patients with MS who have urinary urgency/frequency refractory to 2 different antimuscarinics will be given the option of trying Urgent PC Neuromodulation system (PTNS) for symptomatic relief of their bladder overactivity. Patients will need to fill out a 3 day voiding diary and a validated symptom questionnaires as part of our standard clinical practice prior to enrollment. In particular, patients will be required to complete the OAB questionnaire short form and a score of 18 (total score possible is 36) is required for inclusion in the study. Other questionnaires will include the Urogenital Distress Inventory short form (UDI-6) and Patient Global Impression of Severity Scale (PGI-S). In addition, they will require a 1 week washout period of antimuscarinic medication. Patients will then be treated according to the Urgent PC protocol (12, 30 minute sessions separated by 7 days between sessions). At the end of the 12 sessions (3 months), patients will be asked to fill out voiding diaries and questionnaires. At each a 3 mo post PTNS visit voiding symptoms will be assessed by both physician interview and by validated symptom questionnaires, also part of our standard. Urinary flow rate and post-void residual by bladder scan measurement will be obtained at each visit. All study procedures are considered standard of care and this study is assessing the results of the procedures so it is observational.
Diagnosis of Multiple Sclerosis
2. Failure of symptomatic relief with 2 different anti-muscarinic medications
3. Minimal score of 18 on OAB questionnaire
4. Willingness to return to Aston Clinic once a week for 12 weeks to complete study protocol.