The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review

Abstract

Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups, most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.

Transcutaneous posterior tibial nerve stimulation: Ready for prime time?

“…The stimulation could be delivered to the posterior tibial nerve through two distinct routes: using a fine needle (percutaneous‐PTNS) or using a surface electrode (transcutaneous‐PTNS). While sham‐controlled randomized trial (RCT) supporting the use of each of these two approaches for OAB do exist, the worldwide spread of transcutaneous‐PTNS remains more limited despite significant possible advantages such as lower invasiveness and costs . In their manuscript, recently published in NeuroUrology and Urodynamics, Ramirez‐Garcia et al reported the first head‐to‐head randomized controlled comparison of transcutaneous and percutaneous PTNS in overactive bladder (OAB) patients …”

“…These findings were observed while the same regimen of stimulation was used in both groups, that is, weekly sessions of 30 min for 12 weeks. There is a great heterogeneity in the stimulation regimen and volume of hours in the transcutaneous PTNS literature and the program used in this study duplicated the one from several previous randomized controlled trials . However, one may argue that one of the main asset of transcutaneous PTNS was left aside by using such stimulation regimens.…”

“…However, one may argue that one of the main asset of transcutaneous PTNS was left aside by using such stimulation regimens. Indeed, conversely to its percutaneous counterpart that is necessarily performed in the office, transcutaneous PTNS can be self‐administered at home by the patient which gives room for daily stimulation as reported in several prospective cohort studies . An adequately powered trial comparing daily home‐based transcutaneous PTNS versus weekly office‐based percutaneous PTNS may have resulted in substantially different findings in terms of efficacy (some data in the literature suggests that daily PTNS provides better outcomes than weekly PTNS in other indications) and compliance with treatment.…”

“…Aside from these considerations, the Ramirez‐Garcia study adds a significant piece to the increasing body of evidences supporting the use of transcutaneous PTNS in OAB, with already ten randomized trials evaluating this treatment option vs either sham, anticholinergics or behavioral interventions . Despite pending issues such as the optimal stimulation settings and regimens, and lack of data on long term outcomes or cost‐effectiveness, these recent data may expand the use of transcutaneous PTNS outside Europe.…”

“…will be needed to better determine optimal indications of each PTNS option.Aside from these considerations, the Ramirez-Garcia study adds a significant piece to the increasing body of evidences supporting the use of transcutaneous PTNS in OAB, with already ten randomized trials evaluating this treatment option vs either sham, anticholinergics or behavioral interventions. 4 Despite pending issues such as the optimal stimulation settings and regimens, and lack of data on long term outcomes or cost-effectiveness, these recent data may expand the use of transcutaneous PTNS outside Europe. With the largest randomized controlled trial comparing transcutaneous PTNS to sham currently ongoing in France in patients with neurogenic lower urinary tract dysfunctions due to Parkinson's Disease (the UROPARKTENS study, clinicaltrials identifier: NCT), the indications may also expand beyond OAB and transcutaneous PTNS may soon become ready for prime time.…”