Hypothesis / aims of study
The coexistence of overactive bladder (OAB) with benign prostatic enlargement (BPE) complicates approximately 60% of cases, representing a significant therapeutic challenge. In men, treatment must balance the relief of voiding symptoms with the preservation of detrusor contractility, a consideration less common in the management of female OAB.
Conventional antimuscarinics may impair bladder contractility, while beta-3 agonists are often contraindicated in patients with severe hypertension or are poorly tolerated due to adverse effects such as headache. Percutaneous Tibial Nerve Stimulation (PTNS) is a guideline-recognized, non-pharmacological option. We hypothesized that PTNS provides significant clinical benefit as an adjunctive treatment in male patients with BPE and OAB symptoms, avoiding the systemic side effects associated with standard pharmacotherapy.
This original study aims to evaluate the efficacy of add-on PTNS in male patients with OAB syndrome and coexisting voiding symptoms or BPE.
Study design, materials and methods
This single-arm prospective study included 54 male patients with OAB undergoing a standard PTNS protocol. Baseline evaluations included the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score (IPSS) to evaluate symptoms severity, along with objective prostate volume measurements to assess concurrent BPE. Longitudinal outcomes were tracked up to treatment Session 8. Primary outcome measures included changes in the OABSS and IPSS. To closely monitor micturition safety, the IPSS was further subdivided into storage and voiding sub-scores. Subjective quality of life was assessed using the Patient Perception of Bladder Condition (PPBC). Statistical analysis was performed using paired t-tests, with significance defined as p < 0.05.
Results
A total of 54 male OAB patients (mean age 65.2±11.5 years) were included. Baseline assessments indicated moderate-to-severe symptoms: OABSS 8.74±3.16, IPSS 15.66±8.00, and PPBC 3.26±1.25. Among patients with available prostate volume (PV) data (n=40), 85.0% had a PV ≥20 ml (mean 35.68±15.77 ml), confirming clinical BPE. For patients with medication records (n=51), 78.5% required combination polypharmacy. (including antimuscarinics 72.5%, α-blockers 66.7%, and β3-agonists 60.8%).
Following PTNS, storage symptoms improved rapidly and significantly. Mean OABSS decreased to 5.82±3.02 by Session 4 (p<0.001) and reached 3.82±3.10 by Session 8 (p<0.001). IPSS storage scores similarly improved from a baseline of 8.79±2.77 to 4.18±2.93 at Session 8 (p<0.001). PTNS demonstrated excellent voiding safety: IPSS voiding scores showed significant early improvement from 6.86±6.30 to 3.86±3.90 at Session 4 (p=0.008) and were safely maintained at 2.45±4.18 by Session 8, without inducing urinary retention. This significant symptom relief enhanced quality-of-life: the proportion of patients reporting "very severe" PPBC problems dropped from 13.2% to 0% after only 3 sessions, while 54.6% reported "very minor/minor" issues by Session 8.
Interpretation of results
These findings demonstrated the clinical value of PTNS in managing complex male OAB. Our cohort represents a highly challenging population: a vast majority (85%) had concurrent prostatic enlargement, and nearly 80% relied on extensive LUTS polypharmacy. In such patients, conventional pharmacological treatments are often maximized, creating a strict clinical dilemma due to the risks of medication-induced voiding dysfunction and side effects. Our study demonstrates that add-on PTNS therapy effectively breaks through these pharmacological limitations. It not only provides rapid and significant relief of storage symptoms but also safely minimizes the adverse effects of voiding dysfunction.