History of Peripheral Tibial Nerve Stimulation in Urology

Abstract

As of 2011, an estimated 29.8 million adults in the United States were living with overactive bladder (OAB).[ 1 Coyne K.S. Sexton C.C. Vats V. et al. National community prevalence of overactive bladder in the United States stratified by sex and age. Urology. 2011; 77: 1081-1087 Google Scholar ] In addition to the daily intrusion in patients’ lives, this condition is associated with higher rates of falls and fractures, urinary tract and skin infections, sleep disturbances, and depression.[ 2 Brown J.S. McGhan W.F. Chokroverty S. Comorbidities associated with overactive bladder. Am J Manag Care. 2000; 6: S574-S579 Google Scholar ] Current guideline-based treatment protocols put forth by The American Urological Association propose a multi-tiered algorithm, beginning with behavioral modifications, followed by pharmacological treatments (anti-muscarinic and β3-adrenoceptor agonists), and finally by third-line therapies including chemical denervation, Sacral Neuromodulation (SNS) or Peripheral Tibial Nerve Stimulation (PTNS). PTNS therapy involves repeated electrical stimulation of the tibial nerve via a small needle inserted cephalad to the medial malleolus. The objective of this study is to examine the evolution of PTNS from acupuncture techniques, evaluate the current literature on patient outcomes for OAB, and discuss recent innovations in the delivery of this technique.