Skip to main content
SpringerLink
Log in

Posterior Tibial Nerve Stimulation for Female Urge Urinary Incontinence

  • Chapter
  • First Online:
Female Urinary Incontinence

  • 920 Accesses

Abstract

The portion of the tibial nerve that runs posterior to the medial malleolus is termed the posterior tibial nerve and originates from L4, L5, S1, S2, and S3. Neuromodulation involving electrical stimulation of the posterior tibial nerve, termed posterior tibial nerve stimulation (PTNS), has been shown to inhibit detrusor contractions and treat urgency incontinence. While the exact mechanism of action is unknown, there has been robust evidence evaluating the efficacy of PTNS in women with urinary urgency incontinence, with favorable outcomes. The adverse event profile of this technology is minimal, with the largest barrier to care being the need for frequent visits to complete the therapy. However, innovative ambulatory and implantable technology that removes this barrier has been developed, and their outcomes are currently being assessed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Mcguire EJ, Shi-chun Z, Horwinski ER, Lytton B. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol. 1983;129:78–9.

    Article  CAS  Google Scholar 

  2. Heesakkers J, Blok B. Electrical stimulation and neuromodulation in storage and emptying failure. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, editors. Campbell Walsh Wein urology. Elsevier; 2021. p. 2739–2755.e3.

    Google Scholar 

  3. Stoller ML, Copeland S, Millard RJ, Murnaghan GF. The efficacy of acupuncture in reversing the unstable bladder in pig-tailed monkeys. J Urol. 1987;137(6):104A.

    Article  Google Scholar 

  4. Stewart F, Gameiro OLF, El Dib R, Gameiro MO, Kapoor A, Amaro JL. Electrical stimulation with non-implanted electrodes for overactive bladder in adults. Cochrane Database Syst Rev. 2016;4:CD010098. https://doi.org/10.1002/14651858.cd010098.pub3.

    Article  PubMed  Google Scholar 

  5. Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202:558–63.

    Article  Google Scholar 

  6. Granger CJ, Cohen-Levy WB. Anatomy, bony pelvis and lower limb, posterior tibial nerve. StatPearls; 2020.

    Google Scholar 

  7. van der Pal F, Heesakkers JPFA, Bemelmans BLH. Current opinion on the working mechanisms of neuromodulation in the treatment of lower urinary tract dysfunction. Curr Opin Urol. 2006;16:261–7.

    Article  Google Scholar 

  8. Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, Finazzi-Agrò E. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol. 2013;13:61.

    Article  Google Scholar 

  9. Takano S. Bilateral transcutaneous posterior tibial nerve stimulation for functional anorectal pain. 2014 IEEE 19th International Functional Electrical Stimulation Society Annual Conference (IFESS). 2014. https://doi.org/10.1109/ifess.2014.7036731

  10. MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC, Siegel SW, Tate SB, Feagins BA. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol. 2010;183:234–40.

    Article  Google Scholar 

  11. Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, Macdiarmid SA. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmmiT trial. J Urol. 2010;183:1438–43.

    Article  Google Scholar 

  12. Ramírez-García I, Blanco-Ratto L, Kauffmann S, Carralero-Martínez A, Sánchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: randomized control trial. Neurourol Urodyn. 2019;38:261–8.

    Article  Google Scholar 

  13. Nuhoğlu B, Fidan V, Ayyildiz A, Ersoy E, Germiyanoğlu C. Stoller afferent nerve stimulation in women with therapy resistant overactive bladder; a 1-year follow up. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:204–7.

    Article  Google Scholar 

  14. Schreiner L, dos Santos TG, Knorst MR, da Silva Filho IG. Randomized trial of transcutaneous tibial nerve stimulation to treat urinary incontinence in older women. Int Urogynecol J. 2010;21:1065–70.

    Article  Google Scholar 

  15. van Balken MR, Vandoninck V, Gisolf KW, Vergunst H, Kiemeney LA, Debruyne FM, Bemelmans BL. Posterior tibial nerve stimulation as neuromodulative treatment of lower urinary tract dysfunction. J Urol. 2001;166:914–8.

    Article  Google Scholar 

  16. Finazzi Agrò E, Campagna A, Sciabica F, Petta F, Germani S, Zuccalà A, Miano R. Posterior tibial nerve stimulation: is the once-a-week protocol the best option? Minerva Urol Nefrol. 2005;57:119–23.

    PubMed  Google Scholar 

  17. Yoong W, Ridout AE, Damodaram M, Dadswell R. Neuromodulative treatment with percutaneous tibial nerve stimulation for intractable detrusor instability: outcomes following a shortened 6-week protocol. BJU Int. 2010;106:1673–6.

    Article  Google Scholar 

  18. Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189:2194–201.

    Article  Google Scholar 

  19. Yoong W, Shah P, Dadswell R, Green L. Sustained effectiveness of percutaneous tibial nerve stimulation for overactive bladder syndrome: 2-year follow-up of positive responders. Int Urogynecol J. 2013;24:795–9.

    Article  CAS  Google Scholar 

  20. Blanker MH, Alma HJ, Devji TS, Roelofs M, Steffens MG, van der Worp H. Determining the minimal important differences in the International Prostate Symptom Score and Overactive Bladder Questionnaire: results from an observational cohort study in Dutch primary care. BMJ Open. 2019;9:e032795.

    Article  Google Scholar 

  21. Sirls LT, Tennstedt S, Brubaker L, Kim H-Y, Nygaard I, Rahn DD, Shepherd J, Richter HE. The minimum important difference for the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form in women with stress urinary incontinence. Neurourol Urodyn. 2015;34:183–7.

    Article  Google Scholar 

  22. Booth J, Hagen S, McClurg D, Norton C, MacInnes C, Collins B, Donaldson C, Tolson D. A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. J Am Med Dir Assoc. 2013;14:270–4.

    Article  Google Scholar 

  23. Boaretto JA, Mesquita CQ, Lima AC, Prearo LC, Girão MJBC, Sartori MGF. Comparison of oxybutynin, electrostimulation of the posterior tibial nerve and peroneal exercises in the treatment of overactive bladder syndrome. Fisioter Pesqui. 2019;26:127–36.

    Article  Google Scholar 

  24. Finazzi-Agrò E, Petta F, Sciabica F, Pasqualetti P, Musco S, Bove P. Percutaneous tibial nerve stimulation effects on detrusor overactivity incontinence are not due to a placebo effect: a randomized, double-blind, placebo controlled trial. J Urol. 2010;184:2001–6.

    Article  Google Scholar 

  25. Brandon C, Oh C, Brucker BM, Rosenblum N, Ferrante KL, Smilen SW, Nitti VW, Pape DM. Persistence in percutaneous tibial nerve stimulation treatment for overactive bladder syndrome is best predicted by patient global impression of improvement rather than symptom-specific improvement. Urology. 2021;148:93–9. https://doi.org/10.1016/j.urology.2020.12.009.

    Article  PubMed  Google Scholar 

  26. Te Dorsthorst MJ, Heesakkers JPFA, van Balken MR. Long-term real-life adherence of percutaneous tibial nerve stimulation in over 400 patients. Neurourol Urodyn. 2020;39:702–6.

    Article  Google Scholar 

  27. Yamashiro J, de Riese W, de Riese C. New implantable tibial nerve stimulation devices: review of published clinical results in comparison to established neuromodulation devices. Res Rep Urol. 2019;11:351–7.

    PubMed  PubMed Central  Google Scholar 

  28. Te Dorsthorst M, van Balken M, Heesakkers J. Tibial nerve stimulation in the treatment of overactive bladder syndrome: technical features of latest applications. Curr Opin Urol. 2020;30:513–8.

    Article  Google Scholar 

  29. Overactive bladder treatment using StimRouter neuromodulation system: a prospective randomized trial. https://clinicaltrials.gov/ct2/show/NCT02873312?term=stimrouter&cond=oab&draw=2&rank=1. Accessed 28 Jan 2021.

  30. Heesakkers JPFA, Digesu GA, van Breda J, Van Kerrebroeck P, Elneil S. A novel leadless, miniature implantable Tibial Nerve Neuromodulation System for the management of overactive bladder complaints. Neurourol Urodyn. 2018;37:1060–7.

    Article  Google Scholar 

  31. MacDiarmid S, Staskin DR, Lucente V, et al. Feasibility of a fully implanted, nickel sized and shaped tibial nerve stimulator for the treatment of overactive bladder syndrome with urgency urinary incontinence. J Urol. 2019;201:967–72.

    Article  Google Scholar 

  32. Seth JH, Gonzales G, Haslam C, Pakzad M, Vashisht A, Sahai A, Knowles C, Tucker A, Panicker J. Feasibility of using a novel non-invasive ambulatory tibial nerve stimulation device for the home-based treatment of overactive bladder symptoms. Transl Androl Urol. 2018;7:912–9.

    Article  Google Scholar 

  33. Rigoard P. The tibial nerve. In: Rigoard P, editor. Atlas of anatomy of the peripheral nerves. Cham: Springer; 2017.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Giulia Lane

Authors
  1. Giulia Lane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giulia Lane .

Editor information

Editors and Affiliations

  1. Urology, University of Michigan, Ann Arbor, MI, USA

    Anne P. Cameron

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Lane, G. (2022). Posterior Tibial Nerve Stimulation for Female Urge Urinary Incontinence. In: Cameron, A.P. (eds) Female Urinary Incontinence. Springer, Cham. https://doi.org/10.1007/978-3-030-84352-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-84352-6_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-84351-9

  • Online ISBN: 978-3-030-84352-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation