title: Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review.
abstract: BACKGROUND
  Tibial nerve stimulation (TNS) is a promising therapy for non-neurogenic lower urinary tract dysfunction and might also be a valuable option for patients with an underlying neurological disorder.
  
  
  OBJECTIVE
  We systematically reviewed all available evidence on the efficacy and safety of TNS for treating neurogenic lower urinary tract dysfunction (NLUTD).
  
  
  METHODS
  The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
  
  
  RESULTS
  After screening 1943 articles, 16 studies (4 randomized controlled trials [RCTs], 9 prospective cohort studies, 2 retrospective case series, and 1 case report) enrolling 469 patients (283 women and 186 men) were included. Five studies reported on acute TNS and 11 on chronic TNS. In acute and chronic TNS, the mean increase of maximum cystometric capacity ranged from 56 to 132mL and from 49 to 150mL, and the mean increase of bladder volume at first detrusor overactivity ranged from 44 to 92mL and from 93 to 121mL, respectively. In acute and chronic TNS, the mean decrease of maximum detrusor pressure during the storage phase ranged from 5 to 15cm H2O and from 4 to 21cm H2O, respectively. In chronic TNS, the mean decrease in number of voids per 24h, in number of leakages per 24h, and in postvoid residual ranged from 3 to 7, from 1 to 4, and from 15 to 55mL, respectively. No TNS-related adverse events have been reported. Risk of bias and confounding was high in most studies.
  
  
  CONCLUSIONS
  Although preliminary data of RCTs and non-RCTs suggest TNS might be effective and safe for treating NLUTD, the evidence base is poor, derived from small, mostly noncomparative studies with a high risk of bias and confounding. More reliable data from well-designed RCTs are needed to reach definitive conclusions.
  
  
  RESULTS
  Early data suggest tibial nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required.
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland; Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland.
authors.forename: Marc P
authors.initials: MP
authors.lastname: Schneider
authors.affiliation: Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gross
authors.affiliation: Medignition Inc., Research Consultants, Zürich, Switzerland.
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Bertil F M
authors.initials: BF
authors.lastname: Blok
authors.affiliation: Department of Urology, University Hospital of the Canary Island, Tenerife, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Castro-Diaz
authors.affiliation: Department of Neuro-Urology, Careggi University Hospital, Florence, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Del Popolo
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.affiliation: Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Urology, Aix Marseille University, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.affiliation: Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lisette 't
authors.initials: L'
authors.lastname: Hoen
authors.affiliation: Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D013979:Tibial Nerve; D001750:Urinary Bladder, Neurogenic / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000628:therapy*
keywords: Electric nerve stimulation; Neurogenic lower urinary tract dysfunction; Percutaneous tibial nerve stimulation; Systematic review; Transcutaneous tibial nerve stimulation