title: Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review.
abstract: BACKGROUND
  Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions.
  
  
  METHODS
  A literature search using MEDLINE and ISI web was performed. Search terms used were "tibial nerve" and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed.
  
  
  RESULTS
  PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered.
  
  
  CONCLUSIONS
  PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS.
authors.affiliation: Department of Urology, Policlinico Tor Vergata, Rome, Italy. efinazzi@tin.it.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Gaziev
authors.forename: Luca
authors.initials: L
authors.lastname: Topazio
authors.forename: Valerio
authors.initials: V
authors.lastname: Iacovelli
authors.forename: Anastasios
authors.initials: A
authors.lastname: Asimakopoulos
authors.forename: Angelo
authors.initials: A
authors.lastname: Di Santo
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Enrico
authors.initials: E
authors.lastname: Finazzi-Agrò
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004599:Electric Stimulation Therapy / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D016239:MEDLINE / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D013979:Tibial Nerve; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000628:therapy*; D014555:Urination Disorders / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult