Tibial nerve stimulation (TNS) is a recognised minimally invasive treatment option for bladder overactivity and non-neurogenic lower urinary tract dysfunction. In this systematic review, the role TNS can play in the management of neurogenic lower urinary tract dysfunction is evaluated using the evidence to date. Due to the heterogeneous nature of studies, and variable outcomes, a meta-analysis was not possible. Sixteen studies were reviewed after the exclusion criteria were applied, with a total of 469 patients included. The majority of patients had multiple sclerosis (n=279), followed by Parkinson’s disease, cerebrovascular accident, and spinal cord injury. Five of these studies evaluated acute TNS with 11 evaluating chronic TNS. Overall the studies did appear to demonstrate a benefit of TNS on a variety of parameters. The increase of maximum cystometric capacity ranged from 56-132ml in acute TNS and 49-150ml in chronic TNS. Mean bladder volumes at first detrusor overactivity increased, with a decrease in maximum detrusor pressure during the storage phase. In chronic TNS, a decrease in number of voids per 24 hours, leakages per 24 hours and post-void residuals were also seen. No adverse reported events relating to TNS were reported. Of note, high risk of bias and confounding was identified in both randomised controlled trials and non-randomised control trials. The studies included were small, with a maximum of 83 patients included and the majority including less than 50 patients, and thereby underpowered. Although the level of evidence is therefore low, the results of this review provide a promising basis for future randomised controlled trials looking into the benefits of TNS for neurogenic lower urinary tract dysfunction. 

Tibial nerve stimulation for treating neurogenic lower urinary tract dysfunction: a systematic review.
Schneider MP, Gross T, Bachmann LM, et al.
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Sophia Cashman

Cambridge University Hospitals NHS Foundation Trust.

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