Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review

Abstract

BackgroundPercutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions.MethodsA literature search using MEDLINE and ISI web was performed. Search terms used were “tibial nerve” and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed.ResultsPTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered.ConclusionsPTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.

Mirabegron as Add-On Treatment to Solifenacin in Patients with Incontinent Overactive Bladder and an Inadequate Response to Solifenacin Monotherapy

“…14 Other alternatives include percutaneous tibial nerve stimulation and sacral nerve stimulation. 15,16 The BESIDE study (NCT01908829) demonstrated a significant benefit with 12 weeks' solifenacin 5 mg plus add-on mirabegron in incontinent OAB patients vs solifenacin 5 and 10 mg monotherapy in terms of improving daily incontinence, micturition frequency and urgency. Furthermore, the safety profile of the combination was similar to that of mirabegron or solifenacin monotherapy.…”

Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

“…In humans, TNS has also become a very promising noninvasive (transcutaneous TNS) or minimally invasive (percutaneous TNS) therapeutic option for refractory lower urinary tract dysfunction. Percutaneous TNS was found to be effective in 37-100% of patients with idiopathic overactive bladder, in 41-100% of those with nonobstructive E U R O P E A N U R O L O G Y X X X ( 2 0 1 5 ) X X X -X X X urinary retention, and in upon 100% of patients with chronic pelvic pain syndrome, children with overactive bladder or dysfunctional voiding, and in patients with NLUTD [7]. In addition, TNS might improve fecal incontinence [33], highlighting the potential in the neurological patient often with both lower urinary tract and bowel dysfunction, although there is no high level of evidence study assessing the combined dysfunction.…”

“…Tibial nerve stimulation (TNS), introduced by Stoller in the late 1990s [6], is a promising therapy for nonneurogenic lower urinary tract dysfunction [7]. The tibial nerve is stimulated by an electrode inserted 4-5 cm cephalad to the medial malleolus.…”

Treatment of Overactive Bladder in Elderly Patients: Clinical Considerations

“…Although there are no specific data in older population, two recent systematic reviews have shown success rates between 37% and 100% in nonresponders to first-line therapy of OAB, with no major complications reported. 88,89 Only temporal effects such as mild-moderate pain in the site of the puncture, bleeding at insertion site, leg cramp, or numbness/pain at the sole of the foot have been reported in about 8.5% of treated patients. Establishing whether these promising results can be expected in the older population is a matter of study.…”