title: Posterior tibial nerve stimulation in the management of lower urinary tract symptoms in patients with multiple sclerosis.
abstract: OBJECTIVE
  Bladder dysfunction is a frequent symptom complex in patients with multiple sclerosis (MS) and often compromises the patient's quality of life. Pharmacotherapy has been poorly studied in the MS population showing contradictory results and reduced compliance owing to intolerable side effects. A new neuromodulation technique known as percutaneous tibial nerve stimulation (PTNS) has shown good efficacy and safety in the treatment of neurogenic and non-neurogenic lower urinary tract symptoms. In this article we review the literature and critically summarise the scientific evidence supporting the use of PTNS in the treatment of lower urinary tract symptoms (LUTS) in patients with MS.
  
  
  METHODS
  We performed a computer-aided literature search in PubMed and EMBASE up to January 2015 to identify randomised controlled trials, case-control trials and prospective observational cohort studies.
  
  
  RESULTS
  A total of 7 open-label, prospective studies and 313 MS patients were included. Three studies reported clinical and urodynamic outcomes at 3 to 9 months after PTNS; one study assessed the long-term efficacy of PTNS; two studies reported the acute effect of PTNS on urodynamic findings; one study assessed whether motor and sensory responses during PTNS could predict treatment outcome. None of the studies included a control group.
  
  
  CONCLUSIONS
  Despite the very limited data PTNS seems an effective and safe treatment option in the management of LUTS in patients with MS.
authors.affiliation: Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Chiara
authors.initials: C
authors.lastname: Zecca
authors.affiliation: Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Letizia
authors.initials: L
authors.lastname: Panicari
authors.affiliation: Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Giulio
authors.initials: G
authors.lastname: Disanto
authors.affiliation: Anestesiologia, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Paolo
authors.initials: P
authors.lastname: Maino
authors.affiliation: St. Mary's Hospital, Imperial College School of Medicine, London, UK.|National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Anand
authors.initials: A
authors.lastname: Singh
authors.affiliation: St. Mary's Hospital, Imperial College School of Medicine, London, UK. a.digesu@imperial.ac.uk.|National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom. a.digesu@imperial.ac.uk.|Urogynaecology Unit, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland. a.digesu@imperial.ac.uk.|Department of Urogynaecology, S. Mary's Hospital, Academic Department of Obstetrics and Gynaecology, Mint Wing, South Wharf, W2 1NY, London, UK. a.digesu@imperial.ac.uk.
authors.forename: G Alessandro
authors.initials: GA
authors.lastname: Digesu
authors.affiliation: Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gobbi
mesh_terms: D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009103:Multiple Sclerosis / Q000150:complications*; D011446:Prospective Studies; D013979:Tibial Nerve; D014563:Urodynamics
keywords: Bladder dysfunction; Lower urinary tract symptoms; Multiple sclerosis; Neuromodulation; Overactive bladder; Percutaneous tibial nerve stimulation