Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines

Abstract

Purpose of the Review. Posterior tibial nerve stimulation (PTNS) techniques have dramatically grown after approval to manage overactive bladder (OAB). The present review will focus on the most current data on PTNS types (percutaneous, transcutaneous, and implant) and their mechanism of action, safety, efficacy, advantages, drawbacks, limitation, and clinical applications. Recent Findings. The present review described the recent studies that addressed the tibial nerve stimulation role in OAB management. BlueWind RENOVA system, Bioness StimRouter, and eCoin are examples of emerging technologies that have evolved from interval sessions (percutaneous PTNS and transcutaneous PTNS) to continuous stimulation (implants). These can be efficiently managed at home by patients with minimum burden on the health system and fewer visits, especially in the COVID-19 pandemic. Summary. Our review shows that the tibial nerve stimulation advancements in OAB treatment have been rapidly increasing over the recent years. It is minimally invasive and effective, similar to sacral nerve stimulation (SNM), but less aggressive. Implantable PTNS has been promised in terms of efficacy, safety, and high acceptance rate. However, evidence is still limited to short-term trials, and tolerability, method, and drawbacks remain challenges.

Neuromodulation in Chronic Pelvic Pain: A Narrative Review

“…The second aspect is placebo: a more effective sham treatment group is required because, despite the RCTs, many studies have employed sham stimulation in the placebo group to simply not activate the device, implying that patients in the control group are likely to be aware that they are not being treated [ 42 , 50 ]. The third aspect is new devices: the development of new devices may potentially improve therapeutic efficacy [ 107 ]. SNM, for example, will lower reoperation rates by developing novel magnetic resonance imaging-safe or rechargeable devices that do not require surgical replacement of the generator [ 35 ].…”

Comparison of different types of therapy for overactive bladder: A systematic review and network meta-analysis

“…When patients are refractory to first- and second-line overactive bladder treatments, clinicians can provide third-line therapy, including OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS) ( 3 , 14 , 15 ). Sacral neuromodulation and peripheral tibial nerve stimulation are novel modalities and have been rapidly increasing over recent years ( 16 , 17 ). Limin Liao et al confirmed the effectiveness and safety of a novel sacral stimulation system that stimulates the sacral nerve for the treatment of overactive bladder ( 18 ).…”

“…Limin Liao et al confirmed the effectiveness and safety of a novel sacral stimulation system that stimulates the sacral nerve for the treatment of overactive bladder ( 18 ). Abdullah Al-Danakh et al suggested that peripheral tibial nerve stimulation was promising in terms of efficacy, safety, and high acceptance rate ( 16 ). This therapeutic modality was derived by balancing the potential benefits to the patient with the risks, including invasiveness of the treatment, the duration and severity of potential adverse events and the reversibility of potential adverse events.…”

Treatment for overactive bladder: A meta-analysis of tibial versus parasacral neuromodulation

“…With regard to tibial nerve stimulation (TNS), whose electrodes are usually located near the medial malleolus, covering the path of the tibial nerve to innervate S2 to S4 nerves. [ 14 ] Regarding parasacral nerve stimulation (PNS), electrodes are positioned over the parasacral region on the level of S3. [ 11 ] Although TNS and PNS have been proven effective and well-accepted, [ 11 , 13 , 14 ] it is unclear who has better effectiveness and safety profile for patients with OAB.…”

“…[ 14 ] Regarding parasacral nerve stimulation (PNS), electrodes are positioned over the parasacral region on the level of S3. [ 11 ] Although TNS and PNS have been proven effective and well-accepted, [ 11 , 13 , 14 ] it is unclear who has better effectiveness and safety profile for patients with OAB. Therefore, we conducted a meat-analysis to compare the safety and effectiveness of TNS versus PNS in treating patients with OAB and provide a better clinical reference for urologists when making a decision.…”