Percutaneous Posterior Tibial Nerve Stimulation Research Articles

N°313 – Assessing the efficacy of treatment with transcutaneous and percutaneous posterior tibial nerve stimulation for urinary incontinence, fecal incontinence and overactive bladder

N°313 – Assessing the efficacy of treatment with transcutaneous and percutaneous posterior tibial nerve stimulation for urinary incontinence, fecal incontinence and overactive bladder

Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines.

Purpose of the Review. Posterior tibial nerve stimulation (PTNS) techniques have dramatically grown after approval to manage overactive bladder (OAB). The present review will focus on the most current data on PTNS types (percutaneous, transcutaneous, and implant) and their mechanism of action, safety, efficacy, advantages, drawbacks, limitation, and clinical applications. Recent Findings. The present review described the recent studies that addressed the tibial nerve stimulation role in OAB management. BlueWind RENOVA system, Bioness StimRouter, and eCoin are examples of emerging technologies that have evolved from interval sessions (percutaneous PTNS and transcutaneous PTNS) to continuous stimulation (implants). These can be efficiently managed at home by patients with minimum burden on the health system and fewer visits, especially in the COVID-19 pandemic. Summary. Our review shows that the tibial nerve stimulation advancements in OAB treatment have been rapidly increasing over the recent years. It is minimally invasive and effective, similar to sacral nerve stimulation (SNM), but less aggressive. Implantable PTNS has been promised in terms of efficacy, safety, and high acceptance rate. However, evidence is still limited to short-term trials, and tolerability, method, and drawbacks remain challenges.

Impact of integrated neuromuscular inhibition technique versus electro-acupuncture stimulation of posterior tibial nerve in males with chronic pelvic pain of myofascial origin

The aim of the study was to examine the impact of the integrated neuromuscular inhibition technique and electro-acupuncture stimulation of posterior tibial nerve in males diagnosed with chronic pelvic pain of myofascial origin. Sixty male patients with chronic pelvic pain participated in this randomized, single-blind, active-controlled trial and they were randomly divided into 3 groups of equal size. The group A (20 patients) received integrated neuromuscular inhibition technique (INIT) and pelvic floor exercise, the group B (20 patients) received posterior tibial nerve electroacupuncture using TENS acupuncture as a noninvasive pelvic floor muscle neuromodulation technique and pelvic floor exercise, and the control group C (20 patients) received pelvic floor exercise only. Serum cortisol level (SCL) measurement was done, and the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire score was used to assess the severity of symptoms of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The measurements were done at baseline and after the next two months. Comparing the three groups post treatment, our results show that there are statistically significant differences in serum cortisol level and in the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaire score in both group A and B (p<0.05). There are no statistically significant differences in the control group C (p>0.05). The findings of this research showed a significant reduction of blood cortisol level and improvement of NIH CPSI questionnaire total value in men with chronic pelvic pain who used an integrated neuromuscular inhibition technique and percutaneous posterior tibial nerve stimulation, and a non-significant difference in the control group C. The INIT has superiority over electro-acupuncture stimulation of the posterior tibial nerve in reducing pain and improving quality of life.

Importance of some technical aspects of the procedure of percutaneous posterior tibial nerve stimulation in patients with fecal incontinence

IntroductionThe results of percutaneous posterior tibial nerve stimulation (PTNS) in the treatment of fecal incontinence (IF) are modest. The aim of the study is to assess the relationship of some technical aspects with the clinical response: location of the nerve, distal response (motor or sensory) and accommodation. MethodsProspective study of patients with FI undergoing PTNS therapy. The clinical response was assessed using the Wexner scale, defecation diary and anorectal manometry. Results32 patients were studied. The intensity of localization (proximity to the nerve) was not correlated with clinical or manometric changes. Motor response was associated with a decrease on the Wexner scale [12.12 (±5.39) to 7.71 (±4.57) P < .005], the number of episodes of passive incontinence [8.78 (±9.64) to 4.11 (±7.11) P = .025], the total number of incontinence episodes [16.11 (±16.03) to 7.78 (±11.34) P = .009] and the number of days with fecal soiling [6.89 (±5.53) to 2.56 (±4.13) P = .002] and with an increase in the length of the manometric anal canal at rest [4.55 (±0.596) to 4.95 (±0.213) P = .004]. The increase in stimulation (accommodation) was inversely correlated with the decrease in the Wexner scale (r = −0.677 P < .005) and the number of days with soiling (r = −0.650 P = .022). ConclusionsThe motor response during PTNS seems to be related to a better clinical response. The accommodation phenomenon could be associated with worse results. The proximity of the electrode to the nerve does not seem to be important as long as a good distal response is achieved.

Design of a Randomized Controlled Trial of Percutaneous Posterior Tibial Nerve Stimulation for the Treatment of Refractory Fecal Incontinence in Women: The NeurOmodulaTion for Accidental Bowel Leakage Study.

High-level evidence for second-line noninvasive treatments for fecal incontinence in women is limited. We present the rationale for and design of the NeuromOdulaTion for Accidental Bowel Leakage trial, a randomized controlled trial of percutaneous tibial nerve stimulation (PTNS) and validated sham stimulation in women with refractory accidental bowel leakage. The rationale and goals for a 2-part study with a run-in phase, use of a generic pulse generator for PTNS and sham stimulation, masking, participant inclusion, primary and secondary outcome measures, and adverse event collection are described. A superiority design will be used to compare change from baseline in St. Mark's score after 12 weekly stimulation sessions between PTNS and sham. Responders to initial treatment (PTNS or sham) will be assigned to scheduled or "as needed" intervention for up to 1 year. Secondary outcome measures include incontinence episodes and other bowel events recorded in a 14-day electronic bowel diary, general and condition-specific quality of life instruments, adaptive behavior, global impression of improvement, symptom control, and sexual function. Sample size calculations determined that 165 participants (110 PTNS and 55 sham) would provide 90% power to detect greater than or equal to 4-point difference between PTNS and sham in change from baseline in St. Mark's score at 12 weeks. The methods for the NeuromOdulaTion for Accidental Bowel Leakage trial will provide high-level evidence of the effectiveness and optimal maintenance therapy schedule of a low-cost PTNS protocol in community-dwelling women seeking second-line intervention for refractory accidental bowel leakage.

The Sustained Therapeutic Effects of Percutaneous Posterior Tibial Nerve Stimulation in the Treatment of Neurogenic Lower Urinary Tract Symptoms in Patients with Parkinson's Disease: 24-months Clinical and Urodynamic Results

To determine the sustained therapeutic effect of percutaneous posterior tibial nerve stimulation (PTNS) treatment in Parkinson's disease patients with detrusor activity during 24 months. After 12 weeks therapy, PTNS was applied at 14-day intervals for 3 months, 21-day intervals for 3 months and 28-day intervals through 24 months. The patients completed a 3-day voiding diary and ICIQ-SF, OAB-V8, OAB-q SF questionnaires at 3rd, 6th, 9th,12th and 24th month. A total of 76 patients were enrolled in the study. Of these 44 (57.9%) were men and 32 (42.1%) women. The differences of compared parameters at baseline and at the end of 24 months were as follows; daytime frequency decreased by 4.6 voids daily, urge incontinence decreased by 4.2 episodes daily, urgency episodes decreased by 6.2 episodes daily, nocturia decreased by 2.4 voids (P <.001) and voided volume improved by a mean of 71.4 cc (P <.05). When compared with baseline significant improvements were seen in the volume at the first involuntary detrusor contraction (1st IDCV), maximum cystometric capacity (MCC), maximal detrusor pressure at first involuntary detrusor contraction (1st IDC Pdetmax), maximal detrusor pressure at MCC (MCC Pdetmax), detrusor pressure at maximal flow (PdetQmax) and post-void residual volume (PVR) after PTNS treatment at 3, 12, 24 months (P <.001 for each) except maximal flow rate (Qmax) value (P ˃.05). These results have demonstrated the significant improvements both on voiding and urodynamic parameters under PTNS treatment with a tapering protocol for during 24-months in Parkinson's disease with detrusor activity.

Effectiveness of percutaneous posterior tibial nerve stimulation for the management of bowel dysfunction in multiple sclerosis patients

Background: Neurogenic bowel dysfunctions (NBDs) in the form of both fecal incontinence (FI) and functional constipation (FC) are frequent in multiple sclerosis (MS) patients and significantly affect their quality of life. Therapeutic options are limited. Objective: To investigate effectiveness of percutaneous posterior tibial nerve stimulation (PTNS) in MS patients suffering from FI and FC. Methods: Prevalence and severity of FI and FC were prospectively collected among MS patients undergoing 12 weeks of PTNS for neurogenic bladder. The Cleveland Clinic Fecal Incontinence Score (CCFIS) and the Rome III criteria were used to define FI and FC, respectively. Subjective treatment satisfaction was estimated using the Benefit Satisfaction and Willingness to Continue (BSWC) questionnaire. Results: A total of 60 patients undergoing PTNS suffered from NBDs (25 FI+/FC+, 5 FI+/FC–, 30 FI–/FC+). Median CCFIS decreased after PTNS from 12.0 (11.0–13.0) to 8.5 (7.0–11.0, p < 0.001), with particular improvements in liquid and flatal incontinence, pads’ need, and lifestyle restrictions. Seven patients became FC free after PTNS and no patients developed FC during the study (p = 0.023). More than 50% of the patients were satisfied and willing to continue PTNS at study end. Conclusion: PTNS represents a valid minimally invasive alternative treatment for MS patients suffering from NBDs.

Randomized Pilot Trial of Percutaneous Posterior Tibial Nerve Stimulation Versus Medical Therapy for the Treatment of Low Anterior Resection Syndrome: One-Year Follow-up.

Low anterior resection syndrome is significantly associated with a deterioration in the quality of life, and its medical treatment is usually ineffective. The aim of the present study was to establish the efficacy of percutaneous tibial nerve stimulation in treating this syndrome. This is a randomized pilot trial with 1-year follow-up. The study was conducted in a specialized colorectal unit of a tertiary hospital. Patients who underwent neoadjuvant chemoradiotherapy and low anterior rectal resection for cancer with low anterior resection syndrome score ≥21 and ileostomy closed at least 18 months earlier were included. Patients were randomly assigned to receive either percutaneous tibial nerve stimulation plus medical treatment (arm A, n = 6) or medical treatment (arm B, n = 6). Low anterior resection syndrome was assessed using symptom severity and disease-specific quality-of-life scores at baseline, at the end of treatment, and at 1-year follow-up. The primary outcome was a clinical response, defined as a reduction of the low anterior resection syndrome score. Only in group A low anterior resection syndrome score, fecal incontinence severity index, and obstructed defecation syndrome score improved significantly with treatment (35.8 ± 2.5 vs 29.0 ± 3.8 (p = 0.03); 36.8 ± 4.3 vs 18.5 ± 8.0 (p = 0.02); 10.3 ± 3.9 vs 8.0 ± 4.9 (p = 0.009)) and changes were observed in all domains of quality-of-life instruments. In both groups the symptom severity and quality-of-life scores at 1-year follow-up did not differ significantly from those recorded at the end of treatment. The study had a small number of patients and it was underpowered to detect the within-group effect. Percutaneous tibial nerve stimulation could be an effective treatment for low anterior resection syndrome. Additional studies are warranted to investigate clinical effectiveness in low anterior resection syndrome. See Video Abstract at http://links.lww.com/DCR/B371. ESTUDIO PILOTO ALEATORIO DE ESTIMULACIÓN PERCUTÁNEA DEL NERVIO TIBIAL POSTERIOR VERSUS TERAPIA MÉDICA PARA EL TRATAMIENTO DEL SÍNDROME DE RESECCIÓN ANTERIOR BAJA: UN AÑO DE SEGUIMIENTO: El síndrome de resección anterior baja se asocia con un deterioro significativo en la calidad de vida y su tratamiento médico generalmente es ineficaz.El objetivo del presente estudio fue establecer la eficacia de la estimulación percutánea del nervio tibial en el tratamiento de este síndrome.Este es un estudio piloto aleatorio con 1 año de seguimiento.El estudio se realizó en una unidad colorrectal especializada de un hospital terciario.Se incluyeron pacientes que se sometieron a quimiorradioterapia neoadyuvante y resección rectal anterior baja por cáncer con puntaje de síndrome de resección anterior baja ≥ 21 e ileostomía cerrada al menos 18 meses antes.Los pacientes fueron asignados aleatoriamente para recibir estimulación percutánea del nervio tibial + tratamiento médico (brazo A, n = 6) o tratamiento médico (brazo B, n = 6). El síndrome de resección anterior baja se evaluó utilizando puntajes de la gravedad de los síntomas y de calidad de vida específicos de la enfermedad al inicio, al final del tratamiento y al año de seguimiento.El resultado primario fue una respuesta clínica, definida como una reducción de la puntuación del síndrome de resección anterior baja.Solo en el grupo A, el puntaje del síndrome de resección anterior baja, el índice de severidad de incontinencia fecal y el puntaje del síndrome de defecación obstruida mejoraron significativamente con el tratamiento (35.8 ± 2.5 vs 29 ± 3.8, p = 0.03; 36.8 ± 4.3 vs 18.5 ± 8.0, p = 0.02; 10.3 ± 3.9 vs 8.0 ± 4.9, p = 0.009, respectivamente) y se observaron cambios en todos los dominios de los instrumentos de calidad de vida. En ambos grupos, los puntajes de severidad de los síntomas y de calidad de vida al año de seguimiento no difirieron significativamente de los registrados al final del tratamiento.El estudio tuvo un pequeño número de pacientes y no logró suficiente poder para detectar el efecto dentro de grupo.La estimulación percutánea del nervio tibial podría ser un tratamiento efectivo para el síndrome de resección anterior baja. Se requieren estudios adicionales para investigar la efectividad clínica en el síndrome de resección anterior baja. Consulte Video Resumen http://links.lww.com/DCR/B371.

Importancia de algunos aspectos técnicos del procedimiento de estimulación percutánea del nervio tibial posterior en pacientes con incontinencia fecal

The results of percutaneous posterior tibial nerve stimulation (PTNS) in the treatment of fecal incontinence (IF) are modest. The aim of the study is to assess the relationship of some technical aspects with the clinical response: location of the nerve, distal response (motor or sensory) and accommodation. Prospective study of patients with FI undergoing PTNS therapy. The clinical response was assessed using the Wexner scale, defecation diary and anorectal manometry. 32 patients were studied. The intensity of localization (proximity to the nerve) was not correlated with clinical or manometric changes. Motor response was associated with a decrease on the Wexner scale [12.12 (± 5.39) to 7.71 (± 4.57) p < 0.005], the number of episodes of passive incontinence [8.78 (± 9.64) to 4.11 (± 7.11) p = 0.025], the total number of incontinence episodes [16.11 (± 16.03) to 7.78 (± 11.34) p = 0.009] and the number of days with faecal soiling [6.89 (± 5.53) to 2.56 (± 4.13) p = 0.002] and with an increase in the length of the manometric anal canal at rest [4.55 (± 0.596) to 4.95 (± 0.213) p = 0.004]. The increase in stimulation (accommodation) was inversely correlated with the decrease in the Wexner scale (r = -0.677 p < 0.005) and the number of days with soiling (r = -0.650 p = 0.022). The motor response during PTNS seems to be related to a better clinical response. The accommodation phenomenon could be associated with worse results. The proximity of the electrode to the nerve does not seem to be important as long as a good distal response is achieved.

Posterior tibial nerve stimulation vs trospium chloride in treatment of overactive bladder in elderly women

Objective This study aimed to assess the outcome of posterior tibial nerve (PTN) stimulation vs trospium chloride in the treatment of overactive bladder syndrome (OAB) in elderly women regarding safety and efficacy. Patients and methods A prospective randomized study was done on 30 postmenopausal women presented with OAB symptoms (wet or dry) in Al-Zahraa University Hospital from March 2019 to March 2020. Patients were classified into two groups. Group Ι included 15 patients who received trospium chloride. Group ΙΙ included 15 patients who were managed by percutaneous posterior tibial nerve stimulation (PTNS). The authors compared the patients in both groups for OAB symptoms (urgency, frequency, nocturia, and urge urinary incontinence) at 4, 8, and 12 weeks, and for urodynamic parameters at the beginning and the end of treatment. Results There was a statistically significant improvement regarding OAB symptoms and urodynamic parameters at the end of the treatment, with no significant difference between both groups. However, the adverse effects were observed mainly with trospium chloride group (dry mouth, constipation, and headache), which were not detected in the PTNS group. Conclusion The authors concluded that trospium chloride and PTN stimulation had the same effect in the treatment of OAB symptoms, and the two lines of treatment are effective and can be used safely in patients with OAB syndrome. However, PTNS is safe, and associated with significant improvement of OAB symptoms, with no significant adverse effect in comparison with trospium chloride, which led to discontinuation of treatment. However, initial studies showed promise. A more comprehensive evaluation of PTNS is needed to support its universal use for the treatment of OAB syndrome.

Posterior tibial nerve stimulation for overactive bladder\u2014techniques and efficacy

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.

Percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children: Is it effective?

BackgroundTo assess the efficacy and durability of percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children.ResultsTwenty patients with a mean age of 7 ± 3.3 years were included in the study. Subjective success was found in 12 patients (60%) who considered their situation to be better and requested to continue therapy to maintain the response which was considered as a therapeutic success, while eight patients (40%) patients chose not to continue therapy because they did not have symptomatic improvement.ConclusionPosterior tibial nerve stimulation is an effective, minimally invasive method for treatment and is easily applied to induce improvement in overactive bladder symptoms and objective urodynamic changes with negligible side effects.

Transcutaneous posterior tibial nerve stimulation for fecal incontinence: New hope revisited

Background: Neuro-modulation of the pelvic nerves is an effective and promising modality for treating fecal incontinence. Direct sacral nerve stimulation is the most popular for neuro-modulation although it is technically demanding. Percutaneous and transcutaneous posterior tibial nerve stimulations are relatively newer approaches for neuro-modulation and they carry the advantage of being cheaper and less invasive. There is not much published data about the transcutaneous approach and in this study, we are describing our experience with this technique. Objective: This study was conducted to describe and determine the efficacy of percutaneous posterior tibial nerve stimulation in the treatment of fecal incontinence. Design: A prospective descriptive study. Setting: The colorectal clinic in the hospital was prepared with the required equipment. The authors funded all procedures performed and the patients paid no extra charges. Patients and Methods: Our study included 15 patients with fecal incontinence visiting the colorectal clinic in Ain Shams University Hospital. All patients received 12 sessions of electric stimulation, 3 sessions per week for 40 minutes each. Main Outcome Measures: Sample Size Wexner score and the short term effect of the treatment. Sample Size: 15 patients. Results: The study included 11 females and 4 males, 2 patients were excluded from the results. The results showed that there was improvement in mean Wexner score for these patients from 13 before the treatment to 8 after finishing the treatment course. Reassessment after 6 months of treatment revealed no deterioration in their continence. Conclusion: We found that transcutaneous posterior tibial nerve stimulation is an effective, cheap, and tolerable method for treating fecal incontinence. However, long-term follow up is required on larger group of patients to adopt this technique. Limitations: Small sample size, short course follow up.Conflict of Interest: None.

Efficacy of Percutaneous Posterior Tibial Nerve Stimulation for the Management of Fecal Incontinence in Multiple Sclerosis: A Pilot Study

Fecal incontinence is a debilitating and highly prevalent problem among multiple sclerosis patients. Conservative therapies often fail to provide benefit. Posterior tibial nerve stimulation is a minimally invasive neuromodulatory therapy with proven efficacy for fecal incontinence in non-neurological settings. To evaluate the efficacy of posterior tibial nerve stimulation in treating multiple sclerosis-related fecal incontinence. Consecutive multiple sclerosis patients with fecal incontinence that had failed conservative therapy received posterior tibial nerve stimulation between 2012 and 2015. All patients had previously undergone anorectal physiology tests and endoanal ultrasound. Patients whose Wexner incontinence score reduced below 10 post-therapy or halved from baseline were deemed responders. Thirty-three patients (25 female, median age 43 years) were included. Twenty-three (70%) had urge, 4 (12%) passive, and 9 (27%) mixed fecal incontinence. Twenty-six (79%) were classified as responders. The majority of subjects had relapsing-remitting multiple sclerosis (67%); those had a significantly higher response rate (95% vs. 67% and 50% in primary and secondary progressive respectively, P < 0.05). Responders tended to be more symptomatic at baseline and had greater improvements in bowel symptom scores and quality of life scores with therapy. Posterior tibial nerve stimulation demonstrates potential as an effective therapy for fecal incontinence in multiple sclerosis. These findings provide the basis for future more definitive controlled studies.

Successful Therapy of Overactive Bladder Syndrome with Percutaneous Tibial Nerve Stimulation: A Case Report

Introduction: Overactive bladder syndrome is defined as urgency with or without incontinence, often with frequency and nocturia but without infection or other pathology. For the patient, overactive bladder syndrome means an essential loss of quality of life. The therapeutic concept follows a graduated, stepwise scheme. The first step consists of behavioral treatment with bladder training and pelvic floor education as well as local estrogen therapy. Following inadequate response to these measures, it is often necessary to add anti-muscarinic drugs or beta-3 agonists. In case of medical contraindication or insufficient response to pharmacologic treatment, neuromodulation, i.e. percutaneous posterior tibial nerve stimulation, should be routinely offered to overactive bladder syndrome patients. Case Report: We present the case of an 81-year-old woman with long-lasting overactive bladder syndrome without incontinence. Behavioural treatment, local estrogen and anti-muscarinic therapy were unsatisfactory, therefore, an additional treatment employing percutaneous posterior tibial nerve stimulation was implemented. Under this regimen, the symptoms dramatically improved. Conclusion: The reported overall success rate of percutaneous posterior tibial nerve stimulation in the literature ranges from 33 - 71%, with success being defined as more than a 50% decrease in urgency and a 25% reduction of frequency and nocturia, respectively. There is no other therapeutic option for overactive bladder syndrome patients, that reaches similar success rates. Percutaneous posterior tibial nerve stimulation should be routinely offered to overactive bladder syndrome patients and employed as an early step in the treatment of overactive bladder syndrome, sometimes in combination with or even before the introduction of medications.

Clinical utility of neurostimulation devices in the treatment of overactive bladder: current perspectives.

ObjectivesThis review describes the evidence from established and experimental therapies that use electrical nerve stimulation to treat lower urinary tract dysfunction.MethodsClinical studies on established treatments such as percutaneous posterior tibial nerve stimulation (P-PTNS), transcutaneous electrical nerve stimulation (TENS), sacral nerve stimulation (SNS) and sacral anterior root stimulation (SARS) are evaluated. In addition, clinical evidence from experimental therapies such as dorsal genital nerve (DGN) stimulation, pudendal nerve stimulation, magnetic nerve stimulation and ankle implants for tibial nerve stimulation are evaluated.ResultsSNS and P-PTNS have been investigated with high-quality studies that have shown proven efficacy for the treatment for overactive bladder (OAB). SARS has proven evidence-based efficacy in spinal cord patients and increases the quality of life. TENS seems inferior to other OAB treatments such as SNS and P-PTNS but is noninvasive and applicable for ambulant therapy. Results from studies on experimental therapies such as pudendal nerve stimulation seem promising but need larger study cohorts to prove efficacy.ConclusionNeurostimulation therapies have proven efficacy for bladder dysfunction in patients who are refractory to other therapies.SignificanceRefinement of neurostimulation therapies is possible. The aim should be to make the treatments less invasive, more durable and more effective for the treatment of lower urinary tract dysfunction.

Percutaneous Posterior Tibial Nerve Stimulation vs Perianal Application of Glyceryl Trinitrate Ointment in the Treatment of Chronic Anal Fissure: A Randomized Clinical Trial.

Current therapeutic guidelines for the treatment of chronic anal fissure establish a medical approach as the first step. Glyceryl trinitrate ointment is the most popular of the available topical treatments in Spain but it is associated with the appearance of headache. The purpose of this study was to compare the compliance rate among patients receiving glyceryl trinitrate treatment for chronic anal fissure with that among patients receiving percutaneous posterior tibial nerve stimulation. This was a prospective randomized study. The study was conducted at Garcilaso Clinic (Madrid, Spain). Subjects with persistent anal fissure despite hygiene and dietary measures applied over at least a 6-week period were included. Study interventions were perianal application of glyceryl trinitrate ointment (twice daily for 8 weeks) and percutaneous posterior tibial nerve stimulation (30-minute session 2 days per week for 8 weeks). Compliance with the treatment and healing rate of chronic anal fissure in patients receiving glyceryl trinitrate ointment or undergoing percutaneous posterior tibial nerve stimulation were evaluated. Forty patients were included in each group. In the glyceryl trinitrate ointment group, 15% of the patients discontinued treatment because of disabling headaches. There were no adverse effects or treatment withdrawals in the percutaneous posterior tibial nerve stimulation group (p = 0.033). After 8 weeks of treatment, the healing rate in the percutaneous posterior tibial nerve stimulation group was 87.5% vs 65.0% in the glyceryl trinitrate ointment group (p = 0.018). Because the patients were not blinded to the treatment, we cannot rule out a placebo effect derived from the needle insertion in the percutaneous posterior tibial nerve stimulation group. Percutaneous posterior tibial nerve stimulation is a safe and effective alternative that is in some ways superior to glyceryl trinitrate ointment for the treatment of chronic anal fissure.

Effects of percutaneous posterior tibial nerve stimulation on voiding dysfunctions in cerebral palsy: A case report

The present study, conducted on three children with cerebral palsy who had voiding dysfunction. After collecting demographic information, symptoms of voiding dysfunctions were recorded. Then; we did an ultrasonographic evaluation of the bladder to measure residual urine volume. Physiotherapy treatment through percutaneous electrical stimulation of the posterior tibial nerve was performed in 12 sessions. Bladder ultrasonography was repeated after treatment. Abnormal residual urine volume became normal in patients with urinary retention. Percutaneous posterior tibial nerve stimulation reduces symptoms of voiding dysfunctions in children with cerebral palsy.

Electrical stimulation of the saphenous nerve in anesthetized rats: a novel therapeutic approach to treating overactive bladder.

Posterior Tibial Nerve Stimulation (PTNS) is a minimally invasive yet effective therapy for treating overactive bladder (OAB) symptoms with electrical stimulations applied at 20 Hz coupled with amplitudes approximating the foot-twitch threshold (T). However, pre-clinical studies indicate that PTNS-evoked bladder reflexes require stimulation amplitudes exceeding 2T. The objective of this work was to evaluate the presence of secondary low-threshold sensory pathways in the hind-limb region that can be a potential target of activation during clinical PTNS set-up. Given the close proximity of the electrode tip and the cutaneous branches in the lower leg, we hypothesized the concomitant activation of saphenous nerve (SAFN) afferents during percutaneous PTNS. To this end, urodynamic model was established in ten anesthetized rats to investigate (1) the isolated role of SAFN trunk in modulating bladder activity and (2) characterize frequency-dependent changes in inhibitory response at low stimulation amplitudes. Our pre-clinical findings suggest that direct stimulation of SAFN can elicit robust and consistent inhibitory effects at 20 Hz. This novel inhibitory reflex may rationalize the therapeutic effects of clinical PTNS therapy and support the feasibility of enhancing the current algorithm of incontinence care.

Re: The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients with Parkinson’s Disease

Re: The Clinical and Urodynamic Results of Percutaneous Posterior Tibial Nerve Stimulation on Neurogenic Detrusor Overactivity in Patients with Parkinson’s Disease