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Tibial neuromodulation for lower urinary tract dysfunction (idiopathic overactive bladder and non obstructive urinary retention): A review of the literature

Introduction: Idiopathic overactive bladder (OAB) and idiopathic non-obstructive urinary retention (NOUR) are challenging syndromes that significantly impact quality of life. Neuromodulation is a third-line treatment option for these conditions and can be performed by applying electrical current in proximity to the tibial nerve in the ankle. Tibial nerve stimulation (TNS) techniques include percutaneous tibial nerve stimulation (PTNS), transcutaneous tibial nerve stimulation (TTNS), and implantable tibial nerve stimulators (ITNS). This review aims to provide a comprehensive overview of the evidence supporting the use of TNS for idiopathic OAB and NOUR.

Methods: A systematic literature search was conducted using PubMed in April 2024, focusing on TNS techniques for idiopathic OAB and NOUR. References of included articles were also searched. Only RCTs were included for PTNS and TTNS, while all study types were considered for ITNS and NOUR.

Review of Literature: The search yielded 457 articles, with 49 meeting the inclusion criteria: 29 comparative studies, 13 cohort studies on ITNS, and 7 articles on NOUR. PTNS showed significant symptom improvement in idiopathic OAB across multiple RCTs, with efficacy comparable to anticholinergic drugs but with fewer side effects. TTNS, a non-invasive alternative, also demonstrated non-inferiority to PTNS with a high patient satisfaction rate. Emerging ITNS devices, like the eCoin and RENOVA, showed promising results. ITNS and TTNS can be performed or used at home, which might improve patient compliance. However, evidence for TNS in treating NOUR remains limited but suggests potential benefits in symptom reduction.

Conclusion: Tibial nerve stimulation is effective for managing idiopathic OAB, offering significant symptom relief and high patient satisfaction. ITNS devices present a promising long-term solution, addressing adherence issues. Shared decision-making remains a crucial role in choosing the appropriate TNS technique and OAB treatment for patients. Future research should focus on comparative studies in NOUR and further evaluation of ITNS efficacy.

Harry J. Kendall,1,2 Julia Schrijvers,3 John P.F.A. Heesakkers,1

  1. Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
  2. Maastricht University, Maastricht, The Netherlands
  3. Zuyderland Medisch Centrum, Heerlen, The Netherlands
Source: Harry J. Kendall, Julia Schrijvers, John P.F.A. Heesakkers. Tibial neuromodulation for lower urinary tract dysfunction (idiopathic overactive bladder and non obstructive urinary retention): A review of the literature. Continence. Volume 11. 2024. 101326, ISSN 2772-9737. https://doi.org/10.1016/j.cont.2024.101326.