Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of percutaneous tibial nerve stimulation (PTNS) for the treatment of overactive bladder (OAB) syndrome.

Methods

PubMed, Embase, Web of Science and Cochrane Library were searched systematically to identify all the relevant studies. Void frequency per day, nocturia frequency per day, urgency episodes per day, incontinence episodes per day, urodynamic values, success rate and side effects, etc., were extracted from the included studies and analyzed.

Results

Twenty-eight studies with 2461 patients in total were included. Results showed that there was a significant clinical effect on the voiding frequency per day (MD = −2.48; 95% CI −3.19, −1.76; P < 0.001), nocturia frequency per day (MD = −1.57; 95% CI –2.16, −0.99; P < 0.001), urgency episodes per day (MD = −2.20; 95% CI –3.77, −0.62; P = 0.006), incontinence episodes per day (MD = −1.37; 95% CI –1.71, −1.02; P < 0.001), maximum cystometric capacity (MD = 63.76; 95% CI 31.90, 95.61; P < 0.001) and compliance (MD = 7.62; 95% CI 0.61, 14.63; P = 0.033). The pooled success rate was 0.68 (95% CI 0.59, 0.78). The major complication was the pain at the puncture site, but the incidence was low.

Conclusions

PTNS is effective and safe in treating OAB symptoms.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  2. D'Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, Hamid R, Homma Y, Marcelissen T, Rademakers K, Schizas A, Singla A, Soto I, Tse V, de Wachter S, Herschorn S, Standardisation Steering Committee ICS, the ICSWGoTfMLUT, Pelvic Floor S, Dysfunction (2019) The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 38 (2):433–477. https://doi.org/10.1002/nau.23897.

  3. Monteiro S, Riccetto C, Araujo A, Galo L, Brito N, Botelho S. Efficacy of pelvic floor muscle training in women with overactive bladder syndrome: a systematic review. Int Urogynecol J. 2018;29(11):1565–73. https://doi.org/10.1007/s00192-018-3602-x.

    Article  PubMed  Google Scholar 

  4. Powell LC, Szabo SM, Walker D, Gooch K. The economic burden of overactive bladder in the United States: a systematic literature review. Neurourol Urodyn. 2018;37(4):1241–9. https://doi.org/10.1002/nau.23477.

    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(3):558–63. https://doi.org/10.1097/ju.0000000000000309.

    Article  PubMed  Google Scholar 

  6. Chung E, Lee D, Gani J, Gillman M, Maher C, Brennan J, et al. Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder. Med J Aust. 2018;208(1):41–5. https://doi.org/10.5694/mja16.01097.

    Article  PubMed  Google Scholar 

  7. Levy G, Lowenstein L. Overactive bladder syndrome treatments and their effect on female sexual function: a review. Sex Med. 2020;8(1):1–7. https://doi.org/10.1016/j.esxm.2019.08.013.

    Article  PubMed  Google Scholar 

  8. Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn. 2012;31(8):1206–16. https://doi.org/10.1002/nau.22251.

    Article  CAS  PubMed  Google Scholar 

  9. Wibisono E, Rahardjo HE. Effectiveness of short term percutaneous tibial nerve stimulation for non-neurogenic overactive bladder syndrome in adults: a meta-analysis. Acta Medica Indonesiana. 2015;47(3):188–200.

    PubMed  Google Scholar 

  10. Tutolo M, Ammirati E, Heesakkers J, Kessler TM, Peters KM, Rashid T, et al. Efficacy and safety of sacral and percutaneous tibial neuromodulation in non-neurogenic lower urinary tract dysfunction and chronic pelvic pain: a systematic review of the literature. Eur Urol. 2018;73(3):406–18. https://doi.org/10.1016/j.eururo.2017.11.002.

    Article  PubMed  Google Scholar 

  11. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical Research ed). 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.

    Article  Google Scholar 

  12. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical research ed). 2016;355:i4919. https://doi.org/10.1136/bmj.i4919.

    Article  Google Scholar 

  13. Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56(5):766–71. https://doi.org/10.1016/s0090-4295(00)00727-5.

    Article  CAS  PubMed  Google Scholar 

  14. Govier FE, Litwiller S, Nitti V, Kreder KJ Jr, Rosenblatt P. Percutaneous afferent neuromodulation for the refractory overactive bladder: results of a multicenter study. J Urol. 2001;165(4):1193–8.

    Article  CAS  Google Scholar 

  15. Vandoninck V, van Balken MR, Finazzi Agro E, Petta F, Micali F, Heesakkers JP, et al. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32. https://doi.org/10.1002/nau.10111.

    Article  PubMed  Google Scholar 

  16. Karademir K, Baykal K, Sen B, Senkul T, Iseri C, Erden D. A peripheric neuromodulation technique for curing detrusor overactivity: Stoller afferent neurostimulation. Scand J Urol Nephrol. 2005;39(3):230–3. https://doi.org/10.1080/00365590510031147.

    Article  PubMed  Google Scholar 

  17. Nuhoglu B, Fidan V, Ayyildiz A, Ersoy E, Germiyanoglu C. Stoller afferent nerve stimulation in woman with therapy resistant over active bladder; a 1-year follow up. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):204–7. https://doi.org/10.1007/s00192-005-1370-x.

    Article  PubMed  Google Scholar 

  18. Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055–61. https://doi.org/10.1016/j.juro.2009.05.045.

    Article  CAS  PubMed  Google Scholar 

  19. Finazzi-Agr E, Petta F, Sciobica 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(5):2001–6. https://doi.org/10.1016/j.juro.2010.06.113.

    Article  Google Scholar 

  20. Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438–43. https://doi.org/10.1016/j.juro.2009.12.036.

    Article  PubMed  Google Scholar 

  21. 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(11):1673–6. https://doi.org/10.1111/j.1464-410X.2010.09461.x.

    Article  PubMed  Google Scholar 

  22. Marchal C, Herrera B, Antuna F, Saez F, Perez J, Castillo E, et al. Percutaneous tibial nerve stimulation in treatment of overactive bladder: when should retreatment be started? Urology. 2011;78(5):1046–50. https://doi.org/10.1016/j.urology.2011.07.1394.

    Article  PubMed  Google Scholar 

  23. Gungor Ugurlucan F, Onal M, Aslan E, Ayyildiz Erkan H, Kizilkaya Beji N, Yalcin O. Comparison of the effects of electrical stimulation and posterior tibial nerve stimulation in the treatment of overactive bladder syndrome. Gynecol Obstet Investig. 2013;75(1):46–52. https://doi.org/10.1159/000343756.

    Article  Google Scholar 

  24. Vecchioli-Scaldazza C, Morosetti C, Berouz A, Giannubilo W, Ferrara V. Solifenacin succinate versus percutaneous tibial nerve stimulation in women with overactive bladder syndrome: results of a randomized controlled crossover study. Gynecol Obstet Investig. 2013;75(4):230–4. https://doi.org/10.1159/000350216.

    Article  Google Scholar 

  25. Kizilyel S, Karakeci A, Ozan T, Unus I, Barut O, Onur R. Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder. Turkish J Urol. 2015;41(4):208–14. https://doi.org/10.5152/tud.2015.94210.

    Article  Google Scholar 

  26. Preyer O, Umek W, Laml T, Bjelic-Radisic V, Gabriel B, Mittlboeck M, et al. Percutaneous tibial nerve stimulation versus tolterodine for overactive bladder in women: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol. 2015;191:51–6. https://doi.org/10.1016/j.ejogrb.2015.05.014.

    Article  CAS  PubMed  Google Scholar 

  27. Kabay S, Kabay SC, Cetiner M, Mestan E, Sevim M, Ayas S, et al. The clinical and urodynamic results of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease. Urology. 2016;87:76–81. https://doi.org/10.1016/j.urology.2015.09.026.

    Article  PubMed  Google Scholar 

  28. Musco S, Serati M, Lombardi G, Lumi E, Parisi AI, Del Popolo G, et al. Percutaneous tibial nerve stimulation improves female sexual function in women with overactive bladder syndrome. J Sex Med. 2016;13(2):238–42. https://doi.org/10.1016/j.jsxm.2015.12.025.

    Article  PubMed  Google Scholar 

  29. Del Rio-Gonzalez S, Aragon IM, Castillo E, Milla-Espana F, Galacho A, Machuca J, et al. Percutaneous tibial nerve stimulation therapy for overactive bladder syndrome: clinical effectiveness, urodynamic, and durability evaluation. Urology. 2017;108:52–8. https://doi.org/10.1016/j.urology.2017.04.059.

    Article  PubMed  Google Scholar 

  30. Kabay SC, Kabay S, Mestan E, Cetiner M, Ayas S, Sevim M, et al. Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results. Neurourol Urodyn. 2017;36(1):104–10. https://doi.org/10.1002/nau.22868.

    Article  PubMed  Google Scholar 

  31. Scaldazza CV, Morosetti C, Giampieretti R, Lorenzetti R, Baroni M. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Int Braz J Urol : Off J Brazilian Soc Urol. 2017;43(1):121–6. https://doi.org/10.1590/s1677-5538.Ibju.2015.0719.

    Article  Google Scholar 

  32. van Breda HMK, Martens FMJ, Tromp J, Heesakkers J. A new implanted posterior tibial nerve stimulator for the treatment of overactive bladder syndrome: 3-month results of a novel therapy at a single Center. J Urol. 2017;198(1):205–10. https://doi.org/10.1016/j.juro.2017.01.078.

    Article  PubMed  Google Scholar 

  33. Vecchioli-Scaldazza C, Morosetti C. Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months. Int Braz J Urol : Off J Brazilian Soc Urol. 2018;44(1):102–8. https://doi.org/10.1590/s1677-5538.Ibju.2016.0611.

    Article  Google Scholar 

  34. Ibrahim H, Shouman AM, Ela W, Ghoneima W, Shoukry AI, ElSheemy M, Morsi H, Badawy H, Eissa M, Kotb S (2019) Percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children: is it effective? African J Urol 25 (1) (no pagination) (10). https://doi.org/10.1186/s12301-019-0009-y.

  35. Iyer S, Laus K, Rugino A, Botros C, Lozo S, Botros SM, et al. Subjective and objective responses to PTNS and predictors for success: a retrospective cohort study of percutaneous tibial nerve stimulation for overactive bladder. Int Urogynecol J. 2019;30(8):1253–9. https://doi.org/10.1007/s00192-018-3822-0.

    Article  PubMed  Google Scholar 

  36. Ramirez-Garcia I, Blanco-Ratto L, Kauffmann S, Carralero-Martinez A, Sanchez 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(1):261–8. https://doi.org/10.1002/nau.23843.

    Article  CAS  PubMed  Google Scholar 

  37. Jiang JF, Leung AK, Pettitt-Schieber B, Nabavizadeh R, Thomas RL, Brown M, et al. Efficacy of percutaneous tibial nerve stimulation for overactive bladder in women and men at a safety net hospital. J Urol. 2020;203(2):385–91. https://doi.org/10.1097/ju.0000000000000539.

    Article  PubMed  Google Scholar 

  38. Jung CE, Menefee SA, Diwadkar GB. 8 versus 12 weeks of percutaneous tibial nerve stimulation and response predictors for overactive bladder. Int Urogynecol J. 2020. https://doi.org/10.1007/s00192-019-04191-6.

  39. Tudor KI, Seth JH, Liechti MD, Ochulor J, Gonzales G, Haslam C, et al. Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder. Clin Autonomic Res: Off J Clin Autonomic Res Soc. 2020;30(1):61–7. https://doi.org/10.1007/s10286-018-0553-8.

    Article  Google Scholar 

  40. Martin-Garcia M, Crampton J. A single-blind, randomized controlled trial to evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in overactive bladder symptoms in women responders to percutaneous tibial nerve stimulation (PTNS). Physiotherapy. 2019;105(4):469–75. https://doi.org/10.1016/j.physio.2018.12.002.

    Article  PubMed  Google Scholar 

  41. Lo CW, Wu MY, Yang SS, Jaw FS, Chang SJ. Comparing the efficacy of onabotulinumtoxinA, sacral neuromodulation, and peripheral tibial nerve stimulation as third line treatment for the management of overactive bladder symptoms in adults: systematic review and network meta-analysis. Toxins. 2020;12(2). https://doi.org/10.3390/toxins12020128.

  42. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database System Rev. 2019;10:ED000142. https://doi.org/10.1002/14651858.ED000142.

    Article  Google Scholar 

  43. Finazzi-Agro E, Rocchi C, Pachatz C, Petta F, Spera E, Mori F, et al. Percutaneous tibial nerve stimulation produces effects on brain activity: study on the modifications of the long latency somatosensory evoked potentials. Neurourol Urodyn. 2009;28(4):320–4. https://doi.org/10.1002/nau.20651.

    Article  PubMed  Google Scholar 

Download references

Funding

This work was funded by the 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (ZYGD18011, ZYJC18015, ZY2016104), Project of Sichuan Provincial Health Department (ZH2017–101) and Project of Science and Technology Department of Sichuan Province (2018SZ0118).

Author information

Author notes

  1. Menghua Wang and Zhongyu Jian contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People’s Republic of China

    Menghua Wang, Zhongyu Jian, Yucheng Ma, Xi Jin, Hong Li & Kunjie Wang

  2. West China Biomedical Big Data Center, Sichuan University, Chengdu, People’s Republic of China

    Zhongyu Jian

Authors
  1. Menghua Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhongyu Jian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yucheng Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xi Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kunjie Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MH Wang: Project development, Data collection, Manuscript writing.

ZY Jian: Project development, Data collection, Manuscript writing.

YC Ma: Data collection, Manuscript writing.

X Jin: Data collection, Manuscript writing.

H Li: Project development, Manuscript revision.

KJ Wang: Project development, Manuscript revision.

Corresponding author

Correspondence to Kunjie Wang.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 30 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, M., Jian, Z., Ma, Y. et al. Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J 31, 2457–2471 (2020). https://doi.org/10.1007/s00192-020-04429-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04429-8

Keywords

Search

Navigation