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Open Access Highly Accessed Research article

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

Gabriele Gaziev1, Luca Topazio1, Valerio Iacovelli1, Anastasios Asimakopoulos2, Angelo Di Santo3, Cosimo De Nunzio4 and Enrico Finazzi-Agrò56*

Author Affiliations

1 School of Specialization in Urology, University of Rome Tor Vergata, Rome, Italy

2 Department of Urology, Policlinico Casilino, Rome, Italy

3 Department of Neuro-Urology, Fondazione S. Lucia, IRCCS, Rome, Italy

4 Department of Urology, Sant'Andrea Hospital, Faculty of Health Sciences "La Sapienza" University of Rome, Rome, Italy

5 Department of Urology, Policlinico Tor Vergata, Rome, Italy

6 Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy

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BMC Urology 2013, 13:61  doi:10.1186/1471-2490-13-61

Published: 25 November 2013

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.

Keywords:
PTNS; OAB; Lower urinary tract dysfunctions; Neurogenic bladder