Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome

Figures & data

Figure 1 Drawing showing the location of the Sanyinjiao point, or Spleen 6 (SP-6), the percutaneous tibial nerve stimulation (PTNS) point, and the technical details.

Table 1 Overview of trials comparing PTNS to other treatments

Reference	Type of study, number of participants (pts)	Intervention (I), comparison (C)	Outcome quality of life (QoL)	Outcome voiding parameters	Conclusion of the authors
Preyer et al^Citation49	RCT, 36 pts	I: Weekly PTNS, 3 months	Visual analog scale Baseline 5.1 (1.2–10) to 1.9 (0–8) at 3 months p=0.002	24-h voiding episodes from 11.3 ± 3.0 to 10.4 ± 4.1, p=0.47 UUI 24-h from 1.5 (0–12) to 0 (0–6), p=0.04	PTNS and tolterodine both effectively reduce UUI and improve QoL in patients with OAB but 24-h voiding frequency did not change. There were no significant differences between treatments. Fewer side effects were seen in the PTNS group
		C: Tolterodine 2 mg bid, 3 months	Visual analog scale Baseline 5.7 (1.5–10) to 2.7 (0–8.5) at 3 months p<0.0001	24-h voiding episodes from 11.3 ± 3.5 to 9.1 ± 3.6, p=0.10 UUI 24-h from 2 (0–12) to 1 (0–5), p=0.02
Peters et al^Citation50	RCT, 100 pts	I: Weekly PTNS, 3 months	Global response assessment reporting cure or improvement, 79.5%	Improvement in UUI, voiding episodes, urgency, CMC in 71%–80%	Subjective improvement of OAB symptoms in both the groups but more favorable for PTNS (p=0.01) No significant difference concerning voiding parameters between the groups. Fewer side effects in the PTNS group
		C: Tolterodine ER 4 mg daily, 3 months	Global response assessment reporting cure or improvement, 54.8%	Improvement in UUI, voiding episodes, urgency, CMC in 73%–76%
Manriquez et al^Citation14	RCT, 70 pts	I: Transcutaneous TNS twice a week, 3 months	OAB-q improvement in all domains p < 0.02	Median 3-day UUI episodes from 5 (0–24) to 0 (0–30), p=0.001 Median 3-day voiding episodes 24 (12-48) to 18 (11-54), p=0.0035	In both the groups, significant reduction of voiding frequency and UUI episodes compared to pre-treatment values. No significant differences between the two intervention groups. There was a similar improvement in QoL scores in both groups after therapy, with a higher improvement in sub domain 2 of the QoL questionnaire in favor of transcutaneous TNS. The other domains 1/3 showed similar improvement in both groups
		C: Oxybutynin ER10 mg daily, 3 months	OAB-q improvement in all domains p < 0.001	Median 3-day UUI episodes from 4 (0–22) to 0 (0–27), p=0.005 Median 3-day voiding episodes 28 (11–55) to 20.5 (9–44), p=0.0011
Vecchioli-Scaldazza et al^Citation51	Crossover RCT, 40 pts	Group A: Solifenacin 5 mg once a day for 40 days followed by PTNS twice a week for 6 weeks after washout period	QoL measured by several questionnaires improved significantly in both group A and B	24-h voiding episodes pre-post Solifenacin in both group A/B Median 12–10 UUI episodes median 4–3 CMC median 120–158	Both Solifenacin and PTNS are effective treatments for OAB with a reduction in 24-h voiding episodes, UUI, increase in cystometric bladder capacity, and QoL
		Group B: vice versa		24-h voiding episodes pre-post PTNS in both groups A/B Median 12–8.5 UUI episodes median 4–1.5 CMC median 110–160
Sancaktar et al^Citation54	RCT, 40 pts	I: Tolterodine 4 mg daily + weekly PTNS (SANS), 3 months	QoL measured by IIQ-7 scores 19 ± 2.0 to 9.0 ± 0.8	Frequency 12.2 ± 1.2 to 4.5 ± 0 Urgency 12.4 ± 0.9 to 5.7 ± 0.6 UUI 22.4 ± 2.8 to 6.4 ± 0.5	Both the treatment modalities resulted in a decline in frequency, urgency, and UUI episodes. QoL improved significantly in both the groups. The combined therapy leads to better clinical outcomes
		C: Tolterodine 4 mg daily, 3 months	QoL measured by IIQ-7 scores 18.1± to 11.2± 2.7	Frequency 12.8 ± 1.3 to 6.4 ± 0.6 Urgency 12.7 ± 1.1 to 7.6 ± 0.9 UUI 22.8 ± 2.4 to 12.3 ± 0.8
Karademir et al^Citation55	RCT, 43 pts	I: Oxybutynin 5 mg daily + weekly PTNS (SANS), 2 months	Not measured	Partial response or complete Response rate in %:  Frequency 44.2%  Urgency 61.1%  UUI 89.1%	Both the treatment modalities resulted in a decline in frequency, urgency, and UUI. No significant difference between both the treatment modalities
		C: weekly PTNS (SANS), 2 months		Partial response or complete Response rate in %:  Frequency 36.7%  Urgency 46.1%  UUI 70.2%
Souto et al^Citation56	RCT, 75 pts	I: Transcutaneous TNS 2× week + oxybutynin 10 mg daily, 3 months C1: oxybutynin 10 mg daily, 3 months	QoL measured by Bother symptom score* 11 (7–16) to 2.9 (0–5) QoL measured by Bother symptom score* 11.8 (8–16) to 4.6 (0–10)	24-h frequency 11.2–7 times Patients with UU in % baseline to end 95%–19% 24-h frequency 11–7.9 times Patients with UU in % baseline to end 100%–31%	All the treatment modalities resulted in significant improvement of OAB symptoms and QoL. No significant difference was found between the groups concerning voiding parameters, but concerning QoL multi-modal treatment was significantly better than monotherapy, p=0.02
		C2: Transcutaneous TNS twice a week, 3 months	QoL measured by Bother symptom score* 10.3 (7–15) to 5.9 (1–11)	Frequency 12.7–8 Patients with UU in % baseline to end 94%–11%

Note:

* Bother symptom score 0 (none)–10 (worst).

Abbreviations: RCT, randomized controlled trial; ER, extended release; UUI, urge urinary incontinence; PTNS, percutaneous tibial nerve stimulation; CMC, cystometric capacity; TNS, tibial nerve stimulation; OAB-q, self-reported quality of life questionnaire; OAB, overactive bladder; IIQ-7, incontinence impact questionnaire; SANS, Stoller afferent nerve stimulation.

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