This article will be of interest to those who undertake percutaneous tibial nerve stimulation (PTNS) or are planning to start doing so. This is a computer aided search between 2000-2011 to identify randomised controlled trials (RCT), controlled clinical trials (CCT) and prospective cohort studies. Neuromodulation is either invasive using implantable electrodes such as sacral nerve stimulation (SNS) or non invasive such as removable devices (transvaginal / transanal) or PTNS. PTNS is also known as stroller afferent nerve stimulation (SANS). Four RCTs and six prospective cohort studies were identified.

The conclusions are:
1) There is strong evidence for PTNS versus sham treatment.
2) There is limited evidence that the use of PTNS and tolterodine is equally effective.
3) There is no additional benefit from a combination of SANS and anticholinergic medication, compared to SANS alone.
4) One negative aspect of these studies is that the trial period varied between six and twelve weeks, which is rather a short follow-up.

More high quality studies are needed to show the level of evidence for PTNS in overactive bladder.

Effects of Percutaneous Tibial Nerve stimulation on adult patients with overactive bladder syndrome: a systematic review.
Moossdorff-steinhauser HFA, Berghmans B.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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