Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin.
OBJECTIVE
To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options.


METHODS
We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes.


RESULTS
Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment.


CONCLUSIONS
TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.
Servicio de Neurofisiología. Hospital Universitario Central de Asturias, Oviedo.
C
C
Valles-Antuña
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo. Electronic address: llanosph@gmail.com.
M L
ML
Pérez-Haro
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
C
C
González-Ruiz de L
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
A
A
Quintás-Blanco
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
E M
EM
Tamargo-Diaz
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
J
J
García-Rodríguez
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
A
A
San Martín-Blanco
Servicio de Urología. Hospital Universitario Central de Asturias, Oviedo.
J M
JM
Fernandez-Gomez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013979:Tibial Nerve; D004561:Transcutaneous Electric Nerve Stimulation; D053202:Urinary Incontinence, Urge / Q000209:etiology / Q000628:therapy*
Estimulación transcutánea; Incontinencia urinaria por urgencia; Nervio tibial; Neuromodulación periférica; Overactive bladder; Peripheral neuromodulation; Tibial nerve; Transcutaneous stimulation; Urge incontinence; Vejiga hiperactiva