Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: a systematic review.
OBJECTIVE
To assess the effectiveness of percutaneous tibial nerve stimulation (PTNS) on adult patients with overactive bladder syndrome, using a systematic review of randomized controlled trials (RCTs), clinical controlled trials (CCTs), and prospective observational cohort studies.


METHODS
A computer-aided literature search was performed in: PubMed, EMBASE and CENTRAL (2000 to November 15, 2011) to identify RCTs, CCTs, and prospective observational cohort studies. The study had to investigate the effect of PTNS on overactive bladder syndrome. The methodological quality of each study was assessed and a qualitative analysis was performed to establish the levels of evidence.


RESULTS
Four RCTs and six prospective observational cohort studies were identified. There is strong evidence for the efficacy of PTNS versus a sham treatment. There is limited evidence that the use of PTNS and tolterodine ER is equally effective. No additional effect of a combination of Stoller afferent nerve stimulation (SANS) and anticholinergic medication compared to SANS alone. Most cohort studies suggested decreased frequency and improvement of incontinence and nocturia. However, the level of evidence was insufficient to make any firm conclusions. Because the total duration of all included trials varied between 6 and 12 weeks, so far there is little information on treatment periods.


CONCLUSIONS
PTNS is efficacious for frequency and urgency urinary incontinence. More high quality studies are needed to improve the level of evidence concerning the efficacy of PTNS with regard to urgency and nocturia, to specify patient selection criteria, optimal treatment modalities and long-term effects as well as the effectiveness in more pragmatic trials.
Fysio Papendrecht, Papendrecht, The Netherlands. heidi.moossdorff@gmail.com
Heidi F A
HF
Moossdorff-Steinhauser
Bary
B
Berghmans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003408:Cresols / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053206:Nocturnal Enuresis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010665:Phenylpropanolamine / Q000627:therapeutic use; D013979:Tibial Nerve; D013997:Time Factors; D000068737:Tolterodine Tartrate; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics; D055815:Young Adult
D001559:Benzhydryl Compounds; D018680:Cholinergic Antagonists; D003408:Cresols; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate