Efficacy Of Tibial Nerve Stimulation Research Articles

Clarifying practical aspects of posterior tibial nerve stimulation for neurogenic overactive bladder: A scoping review

AbstractPatients with neurological diseases often suffer from overactive bladder. Posterior tibial nerve stimulation is mentioned in guidelines as a treatment when antimuscarinics fail or cannot be tolerated by patients, but the evidence is scant. This article summarizes the evidence on the practical aspects of tibial nerve stimulation for neurogenic overactive bladder (NOAB), such as electrical parameters and treatment duration, and identifies areas requiring further investigation. Scoping review. Literature search on PubMed, CINAHL, and Cochrane Library, including studies from 2010 to 2024 regarding tibial nerve stimulation for NOAB. Sixteen papers were considered: seven on transcutaneous tibial nerve stimulation (TTNS), seven on percutaneous tibial nerve stimulation (PTNS) and two protocols. Most studies enrolled neurological and non‐neurological patients or studied non‐randomized samples of a few patients. Clinical outcomes, treatment duration, number of sessions, and follow‐up times showed considerable heterogeneity, but some practical recommendations could be drawn. For PTNS, most authors suggest using 20 Hz and 200 μs, but the amplitude is highly variable among studies. For TTNS, 10 Hz and 200 μs are suggested, with considerable variability in the number of sessions and overall treatment duration. Most papers propose similar criteria regarding the frequency and duration of the stimulation, and all of them support the efficacy of tibial nerve stimulation, except for one. The areas requiring research include long‐term results, allowing for shaping adequate maintenance programmes to avoid losing the results achieved.

Efficacy of Tibial Nerve Stimulation in Neurogenic Lower Urinary Tract Dysfunction Among Patients with Multiple Sclerosis: A Systematic Review and Meta-analysis.

This study was performed to systematically review the current literature on the effects of transcutaneous tibial nerve stimulation and percutaneous tibial nerve stimulation on multiple sclerosis-induced neurogenic lower urinary tract dysfunction. Medical databases including PubMed, Scopus, Embase, and Web of Science were systematically searched from inception to September 2022. Metaanalysis was carried out using the comprehensive meta-analysis tool. Our inclusion criteria were met by 12 studies evaluating the effects of percutaneous tibial nerve stimulation/transcutaneous tibial nerve stimulation on multiple sclerosis-induced neurogenic lower urinary tract dysfunction. Comparing the postintervention results to the baseline showed that the rate of frequency was decreased in both percutaneous tibial nerve stimulation and transcutaneous tibial nerve stimulation groups after intervention. The overall mean change of tibial nerve stimulation on frequency was -2.623 (95% CI: -3.58, -1.66; P < .001, I 2 : 87.04) among 6 eligible studies. The post-void residual was decreased after treatment in both methods of tibial nerve stimulation, with an overall mean difference of -31.13 mL (95% CI: -50.62, -11.63; P=.002, I 2 : 71.81). The other urinary parameters, including urgency (mean difference: -4.69; 95% CI: -7.64, -1.74; P < .001, I 2 : 92.16), maximum cystometric capacity (mean difference: 70.95; 95% CI: 44.69, 97.21; P < .001, I 2 : 89.04), and nocturia (mean difference: -1.41; 95% CI: -2.22, 0.60; P < .001, I 2 : 95.15), were improved after intervention, too. However, the results of subgroup analysis showed no effect of transcutaneous tibial nerve stimulation on urinary incontinence (mean difference: -2.00; 95% CI: -4.06, 0.06; P=.057, I 2 : 95.22) and nocturia (mean difference: -0.39; 95% CI: -1.15, 0.37; P=.315, I 2 : 84.01). In terms of mean voided volume, the evidence was related to only percutaneous tibial nerve stimulation with a mean change of 75.01 mL (95% CI: -39.40, 110.61; P < .001, I 2 : 85.04). Although the current literature suggests that tibial nerve electrostimulation might be an effective method for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and derived from small, mostly nonrandomized trials with a high risk of bias and confounding.

Efficacy of Tibial Nerve Stimulation on Fecal Incontinence in Patients With Low Anterior Resection Syndrome Following Surgery for Colorectal Cancer.

Objective To systematically review the available literature on the efficacy of tibial nerve stimulation on faecal incontinence and quality of life in adult patients with low anterior resection syndrome following surgery for colorectal cancer.MethodsA primary search of electronic databases was conducted adopting a combination of search terms related to the following areas of interest: “efficacy”, “tibial nerve stimulation” and “low anterior resection syndrome”. A secondary search of the grey literature was performed in addition to checking the reference list of included studies and review papers. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A descriptive analysis was used to integrate the review findings.ResultsFive distinct studies involving 116 patients met the inclusion criteria for the review. The included studies suggest that tibial nerve stimulation may have a positive effect on faecal incontinence and quality of life in some patients with low anterior resection syndrome and might be considered as an additional treatment option.ConclusionThere were a limited number of studies and a great degree of heterogeneity of evidence due to differences in participants’ baseline characteristics, dropout rates, and follow-up periods. Further research adopting validated, consistent, and complex outcome assessment methods is recommended to determine the efficacy of tibial nerve stimulation for treatment of patients with low anterior resection syndrome.

MP1-14 POST-STIMULATION INHIBITION OF BLADDER ACTIVITY INDUCED BY TIBIAL NERVE STIMULATION IN RATS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Basic Research I1 Apr 2014MP1-14 POST-STIMULATION INHIBITION OF BLADDER ACTIVITY INDUCED BY TIBIAL NERVE STIMULATION IN RATS Yosuke Matsuta, James Roppolo, William de Groat, Osamu Yokoyama, and Changfeng Tai Yosuke MatsutaYosuke Matsuta More articles by this author , James RoppoloJames Roppolo More articles by this author , William de GroatWilliam de Groat More articles by this author , Osamu YokoyamaOsamu Yokoyama More articles by this author , and Changfeng TaiChangfeng Tai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Tibial nerve stimulation (TNS) is useful to treat overactive bladder symptoms. The efficacy of TNS has been reported to be same as antimuscarinics, however, currently the possible mechanisms underlying TNS are not fully understood. The purpose of this study is to develop an animal model for the investigation of the neural mechanisms underlying TNS. METHODS Experiments were conducted in 29 female Sprague-Dawley rats under urethane anesthesia (1.2 g/kg). A catheter was placed into the bladder to perform cystometrogram (CMG). A cuff electrode was placed around right tibial nerve for stimulation. In 24 rats, 3-5 CMGs were performed initially as control CMGs followed by one CMG with simultaneous TNS (5 Hz, 0.2 ms pulse width) at 2 to 4 times the threshold intensity for inducing an observable toe movement. Then, the rats were divided into 2 groups. In the treated group (n=12), TNS was applied for 30 minutes with the bladder empty. In the control group (n=12), the rats were rested for 30 minutes without TNS. Following the 30-minute treatment, 5 CMGs were performed without TNS to evaluate the post-stimulation effect. Bladder capacity (BC), voiding efficacy (VE), maximum voiding pressure (MVP), contraction duration (CD) and bladder compliance were measured. In 5 rats, electromyogram (EMG) was recorded during CMGs to investigate the effect of TNS on external urethral sphincter (EUS) activity. The base-line and the maximal amplitude of EMG activity, bursting duration and frequency during micturition contraction were measured from the EMG recordings. RESULTS TNS applied during CMG had no acute effect on micturition reflex. However, 30-minute-TNS induced significant post-stimulation effects including a 30-40% increase in BC and a 20-30% increase in bladder compliance during the 5 CMGs following the termination of TNS. There was no change in MVP, CD or VE during the following 5 CMGs. TNS did not induce significant changes of EUS EMG activity either during the stimulation or during the post-stimulation period. CONCLUSIONS These results suggest that TNS in rats has no acute effect but has significant post-stimulation inhibitory effect on micturition reflex. TNS has no effect on EUS activity. This animal model will be useful to further investigate the mechanisms underlying the TNS. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e6 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Yosuke Matsuta More articles by this author James Roppolo More articles by this author William de Groat More articles by this author Osamu Yokoyama More articles by this author Changfeng Tai More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Percutaneous Tibial Nerve Stimulation for Fecal Incontinence

Fecal incontinence is an increasingly common condition with significant negative impact on quality on life and health care resources. It frequently presents a therapeutic challenge to clinicians. Emerging evidence suggests that percutaneous tibial nerve stimulation is an effective treatment for fecal incontinence with the added benefit of being minimally invasive and cost effective. Pursuant to the preliminary report of our early experience of percutaneous tibial nerve stimulation in patients with fecal incontinence published in this journal in 2010, in this dynamic article, we now describe and demonstrate the actual technique that can be performed in a nurse-led clinic or outpatient or community setting. Percutaneous tibial nerve stimulation is a technically simple procedure that can potentially be performed in an outpatient or community setting. The overall early success rate of 68% following its use reported by our unit compares favorably with the success rate following other forms of neuromodulation, including sacral nerve stimulation. When completed, our long-term outcome data will provide further information on the efficacy of tibial nerve stimulation in a larger cohort of patients (n > 100). Future studies, including our currently planned randomized controlled trial of percutaneous tibial nerve stimulation vs sham stimulation, will provide controlled efficacy data and may provide information on its exact mechanism of action.