title: Transcutaneous Electrical Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review.
abstract: Transcutaneous electrical nerve stimulation (TENS) is a promising therapy for non-neurogenic lower urinary tract dysfunction and might also be a valuable option in patients with an underlying neurological disorder.
  
  
  
  We systematically reviewed all available evidence on the efficacy and safety of TENS for treating neurogenic lower urinary tract dysfunction.
  
  
  
  The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
  
  
  
  After screening 1943 articles, 22 studies (two randomised controlled trials, 14 prospective cohort studies, five retrospective case series, and one case report) enrolling 450 patients were included. Eleven studies reported on acute TENS and 11 on chronic TENS. In acute TENS and chronic TENS, the mean increase of maximum cystometric capacity ranged from 69ml to 163ml and from 4ml to 156ml, the mean change of bladder volume at first detrusor overactivity from a decrease of 13ml to an increase of 175ml and from an increase of 10ml to 120ml, a mean decrease of maximum detrusor pressure at first detrusor overactivity from 18 cmH20 to 72 cmH20 and 8 cmH20, and a mean decrease of maximum storage detrusor pressure from 20 cmH20 to 58 cmH2O and from 3 cmH20 to 8 cmH2O, respectively. In chronic TENS, a mean decrease in the number of voids and leakages per 24h ranged from 1 to 3 and from 0 to 4, a mean increase of maximum flow rate from 2ml/s to 7ml/s, and a mean change of postvoid residual from an increase of 26ml to a decrease of 85ml. No TENS-related serious adverse events have been reported. Risk of bias and confounding was high in most studies.
  
  
  
  Although preliminary data suggest TENS might be effective and safe for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and more reliable data from well-designed randomised controlled trials are needed to make definitive conclusions.
  
  
  
  Early data suggest that transcutaneous electrical nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required.
authors.affiliation: Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Gross
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: 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, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Groen
authors.affiliation: Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Lisette A 't
authors.initials: LA
authors.lastname: Hoen
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 Urology, University Hospital of the Canary Island, Tenerife, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Padilla Fernández
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 Neuro-Urology, Careggi University Hospital, Florence, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Musco
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 Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK.
authors.forename: Hazel
authors.initials: H
authors.lastname: Ecclestone
authors.affiliation: Department of Urology, Aix Marseille University, Marseille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.affiliation: Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK.
authors.forename: Véronique
authors.initials: V
authors.lastname: Phé
authors.affiliation: Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
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: D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D004561:Transcutaneous Electric Nerve Stimulation / Q000009:adverse effects; D001750:Urinary Bladder, Neurogenic / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000628:therapy*
keywords: Electric nerve stimulation; Neuro-urology; Neurogenic lower urinary tract dysfunction; Systematic review; TENS; Transcutaneous electrical nerve stimulation