Neuromodulation of the Pudendal, Hypogastric, and Tibial Nerves With Pelvic Floor Muscle Rehabilitation in the Treatment of Urinary Urge Incontinence

ABSTRACT

Objectives. The hypothesis of the study is that adding percutaneous tibial nerve neuromodulation (Urgent PC, Uroplasty Inc., Minneapolis, MN, USA) with pelvic floor muscle rehabilitation (Evadri System, Hollister Inc., Libertyville, IL, USA) is safe, and more successful than either therapy alone for the treatment of urge incontinence. Material and Methods. Two hundred and fifty-six female patients with urge incontinence or mixed incontinence were included in this investigation. Patients were treated sequentially (on the same day) with both pelvic floor muscle rehabilitation and percutaneous tibial nerve neuromodulation twice per week at the Southern Arizona Urogynecology Center, Tucson, Arizona. Results. At three months 93% of the patients were dry. The remaining 7% of patients had a mean improvement of 84% in their incontinence episodes. The median follow-up is now 19 months. There were no adverse side events. Conclusions. Neuromodulation of the pudendal, hypogastric, and tibial nerves is a highly effective treatment for urge incontinence, and superior to either treatment alone by a factor of greater than two times (see Table 1).

Table 1.  Cure (Dry) Rates for PFMR Alone, PTNS Alone, and the Combination of Two

	Cure (dry) rates (%)
* References 9–12. ^† References 20, 22. ^‡ Current manuscript. PFMR, pelvic floor muscle rehabilitation; PTNS, percuataneous tibial nerve neuromodulation.
PFMR^†	30.2–33
PTNS^‡	45–46
Combination (PFMR & PTNS)^§	93