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Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review.

Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agrò E - BMC Urol (2013)

Bottom Line: PTNS 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.PTNS is an effective and safe option to treat OAB patients.Further research is needed to address several unanswered questions about PTNS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Policlinico Tor Vergata, Rome, Italy. efinazzi@tin.it.

ABSTRACT

Background: Percutaneous 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.

Methods: A 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.

Results: PTNS 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.

Conclusions: PTNS 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.

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Stimulator and technique for percutaneous tibial nerve stimulation (PTNS).
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Figure 1: Stimulator and technique for percutaneous tibial nerve stimulation (PTNS).

Mentions: The technique consists of stimulating the nerve by means of a 34 gauge needle electrode inserted 4–5 cm cephalad to the medial malleolus. Once the current is applied, the flexion of the big toe or the movement of the other toes confirms the correct positioning of the needle electrode. The electric current is a continuous, square wave form with a duration of 200 μs and a frequency of 20 Hz. The current intensity is determined by the highest level tolerated by the patient. In Figure 1 the stimulator (Urgent® PC, Uroplasty, Minnetonka, MN, USA) and the technique of stimulation are represented. The stimulation sessions last for 30 minutes and are performed once a week for 10–12 weeks in the majority of published papers. In a report published by Finazzi Agrò et al. [4], the possibility of a more frequent stimulation was analysed: stimulation performed 3 times a week obtained the same results obtained as a weekly stimulation protocol. The advantage of more frequent sessions is to obtain effects in 4 weeks instead of 12: results seemed to be dependent upon the number of stimulations performed and not the time elapsed from the beginning of the stimulation program [4]. In a recent study [5], a protocol of weekly PTNS sessions performed for 6 weeks was evaluated in women with overactive bladder syndrome. The Authors found that this shortened protocol obtained a positive response in 69,7% of 43 women.


Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review.

Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agrò E - BMC Urol (2013)

Stimulator and technique for percutaneous tibial nerve stimulation (PTNS).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222591&req=5

Figure 1: Stimulator and technique for percutaneous tibial nerve stimulation (PTNS).
Mentions: The technique consists of stimulating the nerve by means of a 34 gauge needle electrode inserted 4–5 cm cephalad to the medial malleolus. Once the current is applied, the flexion of the big toe or the movement of the other toes confirms the correct positioning of the needle electrode. The electric current is a continuous, square wave form with a duration of 200 μs and a frequency of 20 Hz. The current intensity is determined by the highest level tolerated by the patient. In Figure 1 the stimulator (Urgent® PC, Uroplasty, Minnetonka, MN, USA) and the technique of stimulation are represented. The stimulation sessions last for 30 minutes and are performed once a week for 10–12 weeks in the majority of published papers. In a report published by Finazzi Agrò et al. [4], the possibility of a more frequent stimulation was analysed: stimulation performed 3 times a week obtained the same results obtained as a weekly stimulation protocol. The advantage of more frequent sessions is to obtain effects in 4 weeks instead of 12: results seemed to be dependent upon the number of stimulations performed and not the time elapsed from the beginning of the stimulation program [4]. In a recent study [5], a protocol of weekly PTNS sessions performed for 6 weeks was evaluated in women with overactive bladder syndrome. The Authors found that this shortened protocol obtained a positive response in 69,7% of 43 women.

Bottom Line: PTNS 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.PTNS is an effective and safe option to treat OAB patients.Further research is needed to address several unanswered questions about PTNS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Policlinico Tor Vergata, Rome, Italy. efinazzi@tin.it.

ABSTRACT

Background: Percutaneous 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.

Methods: A 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.

Results: PTNS 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.

Conclusions: PTNS 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.

Show MeSH
Related in: MedlinePlus