What to do if Percutaneous Tibial Nerve Stimulation (PTNS) Works? A Pilot Study on Home-Based Transcutaneous Tibial Nerve Stimulation

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.

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“…Currently, home administration systems and micro implants are under development and may improve patient compliance and outcomes [17].…”

Section: Percutaneous Tibial Nerve Stimulationmentioning

confidence: 99%

Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update

et al. 2015

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“…It was noted that 30 min/wk with a stimulation parameter of 20 Hz and 200 cycles/s was applied in 3 studies. [ 22 , 24 , 25 ] Notably, the study by Maurelli et al [ 25 ] was a before-after study in which TTNS was used as a maintenance treatment after PTNS. Since the 2 interventions were carried out in the 2 independent phases with available data, it was eventually selected.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding quality assessment of the included studies, ROB domains were judged as low risk in 2 RCTs [ 22 , 23 ] (Figure S1, Supplemental Digital Content). Quality assessment for non-RCTs [ 24 , 25 ] showed that all studies were ranked as high quality (Table S1, Supplemental Digital Content).…”

Section: Resultsmentioning

confidence: 99%

“…In regard to patients’ satisfaction, 2 studies [ 22 , 23 ] provided the data on HRQL scores, and another 2 studies [ 22 , 25 ] presented the data on I-QoL scores. As expected, similar results were noted in terms of HRQL scores (MD = 3.80, 95% CI: −2.47 to 10.06, P = .23) and I-QoL scores (MD = 6.93, 95% CI: −1.27 to 15.13, P = .10) in the TTNS and PTNS group (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Treatment for overactive bladder

2021

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Background: We aim to compare the safety and effectiveness of transcutaneous tibial nerve stimulation (TTNS) versus percutaneous tibial nerve stimulation (PTNS) in treating overactive bladder. Methods: A systematical search on PubMed, Embase, clinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials from January 1, 1999 to November 1, 2020 was performed. The primary outcomes were the changes in a 3-day voiding diary. Quality of life scores were also evaluated. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was applied to conduct all statistical analyses. Results: A total of 4 trials (2 randomized controlled trials, 1 retrospective study, and 1 before-after study) with 142 patients were eventually enrolled. Compared with PTNS, TTNS had a similar performance in the voiding frequency in 24 hours (mean difference [MD] = −0.65, 95% confidence interval [CI]: −1.35 to 0.05, P = .07), the number of urgency episodes in 24 hours (MD = 0.13, 95% CI: −0.36 to 0.62, P = .60), the number of incontinence episodes in 24 hours (MD = 0.01, 95% CI: −0.13 to 0.14, P = .93), as well as in the nocturia frequency (MD = −0.14, 95% CI: −0.52 to 0.24, P = .47). Moreover, comparable results were observed regarding HRQL scores ( P = .23) and incontinence quality of life scores ( P = .10) in both groups. The total complication rate in the current study was 2.1% (3/142). No adverse events were identified in the TTNS group. Conclusion: Current data supported that TTNS is as effective as PTNS for the treatment of overactive bladder, moreover, with no reported adverse events. However, the evidence is low-grade and well-designed prospective studies with a large sample size are warranted to verify our findings.

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“…Another advantage of PTNS is the fact it can be administered by any healthcare provider or the patient themselves after appropriate training. As a matter of fact, home administration systems and micro implants are being developed for that sole purpose [84,88]. PTNS, too, is less costly than SNM, on average [89,90].…”

Section: Mode Of Effectmentioning

confidence: 99%

Neuromodulation in Urology: Current Trends and Future Applications

Yaiesh¹,

Al‐Terki²,

Al-Shaiji³

2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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Urological applications of neuromodulation and neurostimulation are among the most evolving fields for these technologies. First approved for management of refractory urge incontinence, different modalities of neuromodulation and stimulation have been tested, applied and verified for a vast spectrum of voiding and pelvic floor dysfunction disorders. The modalities of delivering this treatment have also evolved in the last three decades, with a focus on sacral neuromodulation. The experimental and established "off-label" applications of neuromodulation have also encompassed chronic pelvic pain disorders, including chronic prostatitis and bladder pain syndrome, among others. In this chapter, we discuss all the hypothesized theories suggested on how this technology provides therapeutic potential for a number of chronic and debilitating urological conditions, the modes of delivery be it anterior, sacral, and posterior tibial to name a few, and the evolving and future applications.

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What to do if Percutaneous Tibial Nerve Stimulation (PTNS) Works? A Pilot Study on Home-Based Transcutaneous Tibial Nerve Stimulation

Abstract: After this pilot study, it is possible to conclude that home-based TTNS is feasible. Nevertheless, further randomized trials are needed before drawing any conclusions.

Cited by 11 publications

References 17 publications

Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update

Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update

Treatment for overactive bladder

Neuromodulation in Urology: Current Trends and Future Applications

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