Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update

Abstract

Neuromodulation is an important treatment modality for a variety of pelvic floor disorders. Percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) are currently the two approved methods for delivering this therapy. Percutaneous tibial nerve stimulation is a minimally invasive office-based procedure that has shown efficacy in the treatment of overactive bladder, fecal incontinence, and pelvic pain. It has the advantage of minimal side effects but is limited by the need for patients to make weekly office visits to receive the series of treatments. Sacral neuromodulation uses an implanted device that stimulates the S3 nerve root and can improve symptoms of overactive bladder, non-obstructive urinary retention, fecal incontinence, and pelvic pain. This paper will review the most recent literature regarding this topic and discuss their advantages and limitations and recent innovations in their use.

Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure

“…Posterior tibial nerve which contains sensory and motor fibers arises from the ventral branches of the fourth and fifth lumbar and first three sacral nerves. As the nerve contains fibers from sacral nerves, stimulation of its peripheral fibers, which reach the ankle area, transmits impulses to the sacral nerves and causes reflex neuromodulation of the rectum and anal sphincter [12,21]. Hence the present study was carried out to assess the effectiveness of TENS procedure in treatment of CAF patients and compare it with LIS.…”

Sacral Neuromodulation in Urological Practice

“…Tibial, pudendal and dorsal genital nerve targets have also been explored to treat voiding complaints. [5][6][7] In 2010 the FDA approved the InterStim® device for the treatment of fecal incontinence. Since 2005, SNM therapy has gone through significant refinement and improvement in techniques from use of fluoroscopy, percutaneous placement of a tined lead, smaller implantable pulse generator (IPG) and the use of wireless test programmers (Verify System®).…”

Sacral Neuromodulation in Non-Obstructive Urinary Retention and Painful Bladder Syndrome: an Update

“…SNM was approved for the treatment of non-obstructive urinary retention in 1999 and thus far has proven to be one of the few effective treatments [3]. It has been shown to restore volitional voiding in patients with an overactive pelvic floor musculature and urethral sphincter [12].…”

“…Since then, there have been significant ameliorations in technique to the point where it is now considered a minimally invasive procedure that can be carried out under local anesthesia [2]. SNM is believed to exert its effect through stimulation of the afferent pathways controlling detrusor function [3]. SNM acts on the S3 nerve root, containing sensory nerve fibers originating in the pelvic floor, which relays parasympathetic motor efferent nerve fibers to exert effect on the external urethral sphincter as well as the pelvic floor musculature [3].…”

“…SNM is believed to exert its effect through stimulation of the afferent pathways controlling detrusor function [3]. SNM acts on the S3 nerve root, containing sensory nerve fibers originating in the pelvic floor, which relays parasympathetic motor efferent nerve fibers to exert effect on the external urethral sphincter as well as the pelvic floor musculature [3]. It is through these mechanisms that SNM is thought to restore bladder function in those with non-obstructive urinary retention and improve pain in those with painful bladder syndrome.…”