الفهرس 
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Abstract
The Aim of this study is focused on comparative study between the efficacy of percutaneous posterior tibial nerve stimulation (PTNS) and propiverine hydrochloride for the treatment of the overactive bladder.
Overactive bladder syndrome negatively affects the daily life of many people. First-line conservative treatments, such as antimuscarinics, do not always lead to sufficient improvement of the complaints and/or are often associated with disabling adverse effects leading to treatment failure. Electrical stimulation of the sacral nerves has emerged as an alternative and attractive treatment for refractory cases of bladder overactivity. Few theories attempted to explain its mechanism of action which remains elusive. It involves percutaneous posterior tibial nerve stimulation and more commonly sacral neuromodulation. The procedure is safe and reversible. It carries a durable success rate. The technique should be combined with careful follow-up and attentive adjustments of the stimulation parameters in order to optimize the clinical outcomes.
Overactive bladder (OAB) also referred to as the urgency-frequency syndrome, with or without urge urinary incontinence can considerably impair the patient’s quality of life. It is widely accepted that diet and life style modifications, behavioural therapy and medication belong to the standard conservative therapeutic options and considered as first-line measures. The International Consultation on Incontinence (ICI) guidelines state that when the first line approach is not fully satisfactory or fails after 8–12 weeks, alternative therapies should be sought out.[1 It is worthwhile and justified to proceed to second-line therapy if patients are refractory to antimuscarinic therapy or if the treatment is contraindicated. Second-line therapies include less-invasive measures such as percutaneous posterior tibial neve stimulation, sacral neuromodulation ,detrusor injections with botulinum toxin (BTX) and whereas more-invasive measures constitute surgical techniques e.g. bladder augmentation or substitution. Pelvic neuromodulation has been proven effective and is today an established treatment option for patients refractory to or intolerant of conservative treatments. It involves percutaneous posterior tibial nerve stimulation (PTNS) .
Recent data suggest that the prevalence of OAB symptoms (using the 2002 International Continence Society (ICS) definition) is closer to 12% in the community; and of these sufferers, approximately 50% experience significant bother from their symptoms.
The initial treatment (Behavioral therapy and pharmacotherapy in the form of anticholinergic agents such as propiverine) mainly aims to reduce the sensation of urgency, increase the voided volume, reduce frequency, and eliminate leakage episodes. If OAB symptoms fail to be controlled by these measures, percutaneous posterior tibial nerve stimulation (PTNS) or any other form of neuromodulation can be introduced to alleviate patient symptoms. If sacral neuromodulation proves to be ineffective, surgery is the last option that can be offered to these patients.
Components of behavioral therapy include education, timed voiding, delayed voiding, dietary modifications, and pelvic floor muscle exercises
Oxybutynin, Tolterodine, propiverine, solifenacin, darifenacin, trospium and fesoterodine are antimuscarinic agents approved for use in OAB treatment.
A combination of behavioral and drug therapy has been shown to be more effective than either treatment alone.
The posterior tibial nerve is a peripheral mixed sensory motor nerve that originates from spinal roots L4 through S3, which also contribute directly to sensory and motor control of the urinary bladder and pelvic floor. Stimulation of the posterior tibial nerve was pioneered by Stoller and colleagues with the introduction of the Stoller afferent nerve stimulator which delivers electrical stimulation to the posterior tibial nerve via a 34-gauge needle just cephalad to the medial malleolus.
Our study included 60 patients divided into two groups (PTNS group and propiverine group).
By using 12 weekly sessions of PTNS, remarkable clinical results were obtained. Percent of the patients which complain of OAB in the PTNS group reported a statistically significant subjective success. These patients chose to continue treatment to maintain the response .
Also patients in the PTNS group showed significant improvement of Frequency (50%), urgency (60%) and urge incontinence (67%) and nocturia (67%) compared to propiverine group frequency (31%) urgency (50%) urge incontinence (50%) and nocturia (33.3%).
No serious side effects were reported, in PTNS group transient pain at the stimulation site was noticed and required no analgesia in 3 patients (10%) of patients while in propiverine group in 8 patients (26.7%) in the form of dry mouth in 5 cases (16.7%), constipation in 2 cases (6.7%) and blurred vision in one case (3.3%).
Our study concluded that PTNS which is minimally invasive and easy applied induce improvement of bladder overactivity symptoms better than propiverine with less side effects.