Abstract
The ideal treatment for overactive bladder is still elusive. In those where medication fails to improve symptoms options include invasive treatments such as botulinum toxin-A, sacral neural stimulation or posterior tibial nerve stimulation. Scientific professional society guidelines advise percutaneous posterior tibial nerve stimulation as a third line treatment option only after multi-disciplinary team review as well as failure of both conservative and pharmacological management. The aim of this article is to review all techniques for tibial nerve stimulation and their efficacy.
Highlights
Overactive bladder (OAB) is defined by the International Continence Society as ‘urinary urgency, with or without frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology’ [1]
There was a statistically significant improvement in urinary frequency, nocturia and urge incontinence episodes in the Percutaneous tibial nerve stimulation (PTNS) group, with the effect seen by week 10 of treatment; 61.5% of participants selfreported > 50% improvement in symptoms with the number of PTNS sessions increasing the odds of subjective success
The studies presented here show the use of Tibial nerve stimulation (TNS) in a heterogeneous group of patients with OAB, refractory OAB and neurogenic OAB, both male and female
Summary
Overactive bladder (OAB) is defined by the International Continence Society as ‘urinary urgency, with or without frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology’ [1]. The posterior tibial nerve is stimulated by inserting a 34-gauge needle 4–5 cephalad to the medial malleolus. Implantable devices to stimulate the tibial nerve were first described by Van der Pal et al (2006) [8] They published outcomes using a subcutaneous implant Urgent-SQ (Uroplasty, Inc., Minnetonka, MN, USA) in eight patients. Patients can adjust only the amplitude between a patient-specific set minimum and maximum This implant is placed over the tibial nerve in an open surgical procedure with antibiotic prophylactic cover usually with local anaesthetic. One month after insertion the operation system is activated using the standard starting parameters of a pulse width of 200 μs and a stimulation frequency of 20 Hz. The minimum amplitude is set to the amplitude with which the patient experiences the first sensation of stimulation and the maximum amplitude was set at the highest tolerable level. Initial results are promising with further studies anticipated [11]
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