PD39-13 PAST, PRESENT, AND FUTURE OF TRANSCUTANEOUS TIBIAL NERVE STIMULATION (tTNS) FOR NEUROGENIC BLADDER IN SPINAL CORD INJURY

INTRODUCTION AND OBJECTIVE:
To review the safety, feasibility, and efficacy of transcutaneous tibial nerve stimulation (tTNS) as a treatment for spinal cord injury (SCI) neurogenic bladder (NB) and outline future directions for the development and optimization of tTNS as a clinical tool.

METHODS:
A series of clinical trials were conducted using tTNS for NB management in people with 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 in people with chronic SCI performing intermittent catheterization (IC) (n=16). The third trial was a double-blinded, RCT designed to measure whether tTNS could replace overactive bladder (OAB) medications (n=50), compared to sham controls, using pre-post patient reported outcomes (PROs) and urodynamic studies (UDS).

RESULTS:
82 people consented to the trials, and none dropped out because of tTNS complications. In the 74 people who completed the trials, tTNS was found to be a safe and feasible treatment option for NB. Satisfaction and feasibility scores were high and there were no adverse events. When used early in SCI, there was evidence of improved NB parameters based on pre-post UDS compared to sham control. A greater percentage of people using tTNS were able to reduce OAB medications compared to sham (95% v 68%, p<0.05) and with a greater 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 safety, feasibility, and efficacy for NB management in SCI, many questions remain before adopting this into usual care. Limitations include lack of long-term outcomes beyond 3-months, and whether compliance was high due to study and selection bias. Current research includes a multicenter study using tTNS early after SCI and continuing for 1-year post-injury, measuring NB outcomes based on UDS and PROs. Planned research includes optimizing the dosing and frequency needed for tTNS. Finally, working with device companies, efforts are being made to develop tTNS devices that can reduce user error in application and control. Although more research is needed, self-administered neuromodulation is within grasp.