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Master Thesis

Critères prédictifs d'efficacité de la stimulation transcutanée unilatérale du nerf tibial dans le contrôle de l'hyperactivité vésicale chez le patient neurologique : une étude rétrospective

Abstract : Introduction: Overactive bladder (OAB) is common in neurological diseases with a double prognosis due to impaired quality of life and risk of complications when associated with a high bladder pressure regimen. Several therapies are currently available, including tibial nerve stimulation (TNS). Despite proven efficacy, there is still insufficient scientific data in terms of mechanisms of action and response criteria. Similarly, the safety of TNS suggests that its place in the treatment of OAB, as a second-line treatment after anticholinergics, could be re-evaluated. The objective of this study was to evaluate the predictive factors of TNS efficacy in OAB in neurological patients in order to redefine its indications, its place in the therapeutic algorithm and to provide elements of reflection on these mechanisms of functioning. Materials and methods: A retrospective study was carried out using the consultation records of 30 patients, over a period from January 2016 to April 2019, who had received unilateral transcutaneous TNS to treat symptoms of OAB. The predictive criteria included socio-demographic data, medical status (pathology, history, treatments), and clinical and urodynamic signs. Clinical efficacy was studied using criteria to assess the improvement of clinical symptoms and quality of life of patients after treatment. Results: A high initial symptoms score would appear to be a positive predictor of TNS efficacy, as well as support for associated urethral insufficiency (female gender, concomitant perineal rehabilitation, and low urethral pressure). No negative predictive factors were found, but some elements appear to be limiting, such as the presence of cognitive impairment or difficulties in accessing the ankle. At the physiotherapeutic level, arguments in favour of an action on perineal spasticity and activation of the external urethral sphincter seem to emerge. Conclusion: Trends would emerge concerning the criteria for the indication of NTS in the treatment of neurological AVH and its place in the therapeutic algorithm, as well as these mechanisms of action. However, further studies are needed.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03123219
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Submitted on : Wednesday, January 27, 2021 - 4:08:51 PM
Last modification on : Wednesday, October 27, 2021 - 5:29:23 AM
Long-term archiving on: : Wednesday, April 28, 2021 - 7:09:45 PM

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  • HAL Id : dumas-03123219, version 1
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Jannick Torval. Critères prédictifs d'efficacité de la stimulation transcutanée unilatérale du nerf tibial dans le contrôle de l'hyperactivité vésicale chez le patient neurologique : une étude rétrospective. Médecine humaine et pathologie. 2020. ⟨dumas-03123219⟩

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