TTNS in SCI Patients With Neurogenic Detrusor Overactivity

This is a prospective, single-arm, pilot study to assess effectiveness and tolerability of transcutaneous tibial nerve stimulation (TTNS) in managing neurogenic detrusor overactivity in spinal cord injury patients. 12 - 16 spinal cord injury patients with neurogenic detrusor overactivity will be recruited. The intervention includes administration of TTNS at the highest tolerated level for 20 minutes daily for 4 weeks, using a neuromodulation device -- Tensi+. Outcome measures including Urodynamic Study (UDS) will be retrieved or collected at baseline and collected after the 4 weeks of TTNS administration. Other outcome measures include Overactive Bladder Questionnaire Short Form (OAB-Q-SF), which will be administered before and after TTNS administration, subject's level of discomfort and any adverse events experienced by the subject will be recorded after each intervention session and a bladder diary will be recorded weekly for subjects not on indwelling urinary catheters. A TTNS satisfaction survey will also be performed at the end of the study.

Inclusion Criteria: 1. Aged between 21 years and 70 years old 2. Clinical diagnosis of spinal cord injury 3. Diagnosis of neurogenic detrusor overactivity 4. Able to tolerate Urodynamic study 5. Ability to provide informed consent Exclusion Criteria: 1. Patients with active implantable device or ankle orthopaedic implant, Ankle articular diseases. 2. Pacemakers or implanted electrical devices, including deep brain stimulation. 3. Ulceration or broken skin in area of TTNS device placement. 4. Patients with BPH: predominantly voiding Lower Urinary Tract Symptoms (LUTS), Uroflow demonstrating obstructive pattern 5. Active urinary tract infection 6. Pregnancy 7. Known bladder tumour, urinary calculi 8. Predominant stress urinary incontinence 9. Prior treatment with transcutaneous PTNS or percutaneous PTNS (any time), sacral neuromodulation (anytime) or intradetrusor botulinum toxin injection within the past 6 months 10. Past medical history of psychiatric conditions 11. Patients with spinal shock 12. Patients with lower motor neuron syndrome