How can we reduce maternal mortality due to preeclampsia? The 4P rule.

OBJECTIVE

To prospectively evaluate the effects of transcutaneous tibial nerve electrical stimulation (TTNS) on urinary symptoms and quality of life in women with neurogenic overactive bladder (nOAB) secondary to ischemic stroke (IS).

METHODS

This was a prospective case series with a six-month follow-up. Women with clinically and radiologically confirmed IS who developed nOAB symptoms persisting for more than six months after the cerebrovascular screened for eligibility. TTNS was administered twice weekly for six weeks, with 30 minute-minute sessions. Electrical stimulation was delivered at the sensory threshold using a fixed frequency of 10Hz and a pulse width of 250 µs. Outcomes were evaluated at baseline, immediately after treatment, and at six months using a one-week bladder diary and the King's Health Questionnaire (KHQ). Statistical analysis was performed using the Friedman test for repeated measures, with a significance threshold of p < 0.05.

RESULTS

Among 236 screened women with IS, 34 (21%) reported persistent nOAB symptoms; 31 completed the study protocol and were included in the final analysis. Mean age was 59.3 ± 13.6 years, and 67.7% were postmenopausal. Detrusor overactivity was identified in 51.6% of urodynamic studies. TTNS produced significant reductions in daytime frequency (11.95 to 6.99 voids/day post-treatment; 7.21 at follow-up), urgency episodes (13.32 to 0.97; 1.35 at follow-up), urge incontinence (9.19 to 0.26; 0.58 at follow-up), and nocturia (2.99 to 0.40; 0.64 at follow-up) (all p < 0.001). Significant improvements were observed across all KHQ domains, including general health perception (58.06 ± 24.48 to 30.65 ± 22.09), incontinence impact (60.22 ± 24.97 to 11.83 ± 22.02), physical and social limitations, emotional well-being, sleep and energy, and severity measures (all p < 0.001). Improvements were sustained at six months, with partial symptom recurrence in 19.6% and complete recurrence in 6.7% of participants.

CONCLUSION

TTNS was associated with significant and sustained improvements in urinary symptoms and quality of life in women with post-stroke nOAB.