Introduction

Posterior Tibial Nerve Stimulation (PTNS) was introduced in UCLH 10 years ago, since then we had approximately 1000 patients referred, with a success rate (RR50) of 70% for Faecal Incontinence (FI).

Since its introduction we have had less reliance on invasive sacral neuromodulation.

With a growing cohort requiring maintenance PTNS in hospital, we offered patients an alternative home therapy called Transcutaneous Tibial Nerve Stimulation (TTNS).

Advantages include fewer trips to hospital, less reliance on hospital therapy and encouraging self-management.

The success rate of PTNS is 63 - 82% and TTNS is 59 -77%.

We report our two year experience of TTNS for FI.

Methods/Materials

Between February 2018 and February 2020 we had 137 patients referred for TTNS treatment of faecal incontinence (FI).

Some were responding to PTNS already and wanted to have a home based therapy. Some were new to neuromodulation.

Both PTNS (Urgent PC device) and TTNS (NeuroTrac device) elicited the same physical responses : tingling along the lateral border of the foot, flexing of the first toe and splaying of the toes.

Success was measured by the RR50 as a composite improvement measure utilising a reduction in 50% incontinent episodes (Wexner Score) and subjective improvement (VAS + Rockwood QoL Scores).

Results

137 patients were referred for TTNS, 50 patients completed the 12 week induction and were suitable for analysis.

Altogether 35 patients (70%) were responders to PTNS, 30 of these (60% : 18female,12male) transitioned successfully to TTNS.

The RR50 of both therapies were similar. The remaining 5 patients (10% : 4female,1male) did not respond to TTNS and reverted to PTNS.

6 patients (12%) responded to first time neuromodulation with TTNS and are on maintenance therapy at home.

The last 9 patients (18%) had no benefit from TTNS, and went onto PTNS but this failed too, this paralles the 20% failure rate of SacralNeuromodulation.

Discussion

Our results support the theory that both modes of neuromodulation may have a similar end effect and efficacy .

This is a non-randomized study with small numbers but translates into real life practice.

Patients should be given the choice of home or hospital therapy with the merits and drawbacks of both, in the context of increasing burden on NHS services.

Conclusions

72% (36/50) were RR50 responders to TTNS

86% (30/35) who responded to PTNS successfully transitioned to home TTNS

TTNS is more cost effective (PTNS £1363 vs TTNS £80)

Non-responders to TTNS also failed to respond to PTNS