OM09 POTENTIAL AND SUCCESSES OF TRANSCUTANEOUS TIBIAL NERVE STIMULATION FOR NEUROGENIC BLADDER MANAGEMENT IN SPINAL CORD INJURY

Introduction: Neurogenic bladder (NB) is a common and debilitating complication for those with spinal cord injury (SCI), resulting in significant impacts on quality of life due to urinary incontinence, infection, and dependence on catheterization or medication. Current treatments, including medications and intermittent catheterization (IC), can be burdensome and have limited efficacy. Neuromodulation therapies such as transcutaneous tibial nerve stimulation (tTNS) have emerged as promising alternatives. This review aims to assess the safety, feasibility, and efficacy of tTNS for NB management in SCI, and to explore its future directions.

Methods: A series of clinical trials were conducted using tTNS for NB management in SCI. The first study was a sham-controlled randomized control trial (RCT) focused on the safety and feasibility of tTNS application in early SCI while in acute inpatient rehabilitation (n = 16). The second study evaluated the potential for self-administered tTNS in the home setting (n = 16). The third trial was a double-blinded, RCT designed to measure if tTNS could replace overactive bladder (OAB) medications (n = 50), compared to sham, using pre-post patient reported outcomes (PROs) and urodynamic studies (UDS).

Results: 82people consented, and none dropped out because of tTNS complications. In the 74people who completed, tTNS was found to be a safe and feasible treatment option for NB. Satisfaction and feasibility scores were high with no adverse events. When used early in SCI, there was evidence of improved NB parameters based on pre-post UDS compared to sham.Additionally, tTNS was able to reduce OAB medications compared to sham (95% v 68%, p < 0.05) and with a reduction (26.2%) in the use of overactive bladder medications, while maintaining stable UDS and PROs, indicating tTNS can reduce the dependency of OAB medications and manage NB symptoms.

Conclusions: While tTNS has shown efficacy for NB management in SCI, many questions remain. Limitations include lack of outcomes beyond 3-months, and whether compliance was high due to bias. Current research includes a multicenter study using tTNS early after SCI for 1-year and measuring NB outcomes based on UDS and PROs. Planned research includes optimizing tTNS protocols.