Methods: The review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with the PRISMA guidelines. PubMed, Embase, and Cochrane Central were searched for studies on PNS, without time or language restriction. The final search date was 12th June 2024.
Results: Of 3,020 records screened, 14 studies were included. Two randomised crossover designs and 12 observational studies included a total of 292 patients, predominantly female (n=198; 68%). Safety data were reported by eight studies with a total of 24 adverse events reported in 199 patients (12.1%). These included infections (n=3; 1.5%), lead displacements (n=5, 2.5%) and unwanted stimulation effects including pain (n=10; 5.0%). All studies reported technical outcomes with varying results depending on approach. Operative duration ranged from 20-130min and conversion from percutaneous nerve evaluation to implant varied from 30%–100%. Seven studies included measures of clinical efficacy for LUTS and showed a reduction of 2.92 (5.57 to 2.65) in mean daily incontinence episodes (95% CI: 1.52 to 4.31), alongside improvements in voiding volumes and frequencies. Four studies reported physiological data, with increases in bladder capacity (factor 1.5-2) and effect on undesired detrusor contractions (UDC). Where directly compared, PNS demonstrated comparable or better outcomes than SNM in symptom reduction.
Conclusion: PNS appears to be a safe and technically feasible therapy. Clinical outcome data suggest beneficial effects in several LUTS populations including urinary incontinence.
Siemen Herroelen,1 Charles Knowles,2,3 Joe Kerrigan-Smith,3 Tara Noone,3 Tim Denison,3 Stefan De Wachter1,3,4
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary university of London, London, UK
- Amber Therapeutics Ltd, London, UK
- Department of urology, ASTARC, Faculty of medicine and health sciences, Antwerp University, Wilrijk, Belgium