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Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
  • Published:
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Abstract

Purpose of Review

Storage and voiding dysfunction are highly prevalent in patients with multiple sclerosis (MS). Many MS patients fail behavioral modifications and oral medications. Neuromodulation in the form of posterior tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) is a potential treatment for this group of patients. We review contemporary and impactful literature regarding neuromodulation in the MS patient with lower urinary tract dysfunction.

Recent Findings

Large-scale randomized trials regarding the use of neuromodulation in the treatment neurogenic lower urinary tract dysfunction are limited. Despite this, several small prospective studies demonstrate durable responses to neuromodulation in the MS patient. Posterior tibial nerve trials reveal improvements in urodynamic parameters, incontinence episodes, post-void residual volumes, and quality of life metrics. Additionally, SNM in the MS patient results in improvements in daytime and nighttime frequency, urgency symptom, and quality of life. Currently, the frequent need for routine spinal MRI scans precludes the use of SNM. Limited research suggests that some MRI use may be safe, but investigation in this area is ongoing.

Summary

Tibial and sacral neuromodulation appear safe and offer significant improvements in lower urinary tract symptoms and quality of life in MS patients who have failed oral medications and behavioral modifications. Though randomized controlled trials are limited in this area, neuromodulation offers great promise to this often refractory and complex patient population. Future studies are warranted and necessary to better evaluate the efficacy of these treatment options.

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Authors and Affiliations

  1. Department of Urology, Stony Brook University Hospital, 101 Nicolls Road, HSC Level 9, Stony Brook, NY, 11794, USA

    William T. Berg & Jason Kim

  2. School of Medicine, Stony Brook University, Stony Brook, NY, USA

    Chris Du

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  1. William T. Berg
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Correspondence to William T. Berg.

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William Berg, Chris Du, and Jason Kim declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Reconstructed Bladder Function & Dysfunction

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Berg, W.T., Du, C. & Kim, J. Tibial Nerve and Sacral Neuromodulation in the Multiple Sclerosis Patient with Voiding Dysfunction. Curr Bladder Dysfunct Rep 13, 294–300 (2018). https://doi.org/10.1007/s11884-018-0495-y

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  • DOI: https://doi.org/10.1007/s11884-018-0495-y

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