Marc P Schneider1, Tobias Gross2, Lucas M Bachmann3, Bertil F M Blok4, David Castro-Diaz5, Giulio Del Popolo6, Jan Groen4, Rizwan Hamid7, Gilles Karsenty8, Jürgen Pannek9, Lisette 't Hoen4, Thomas M Kessler10. 1. 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. 2. Department of Urology, University of Bern, Inselspital, Bern, Switzerland. 3. Medignition Inc., Research Consultants, Zürich, Switzerland. 4. Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands. 5. Department of Urology, University Hospital of the Canary Island, Tenerife, Spain. 6. Department of Neuro-Urology, Careggi University Hospital, Florence, Italy. 7. Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK. 8. Department of Urology, Aix Marseille University, Marseille, France. 9. Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland. 10. Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: tkessler@gmx.ch.
Abstract
CONTEXT: 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). EVIDENCE ACQUISITION: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. EVIDENCE SYNTHESIS: 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. PATIENT SUMMARY: Early data suggest tibial nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required.
CONTEXT: 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). EVIDENCE ACQUISITION: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. EVIDENCE SYNTHESIS: 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. PATIENT SUMMARY: 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: Katarina Ivana Tudor; Jai H Seth; Martina D Liechti; Juliana Ochulor; Gwen Gonzales; Collette Haslam; Zoe Fox; Mahreen Pakzad; Jalesh N Panicker Journal: Clin Auton Res Date: 2018-08-03 Impact factor: 4.435
Authors: Chiara Pavese; Marc P Schneider; Martin Schubert; Armin Curt; Giorgio Scivoletto; Enrico Finazzi-Agrò; Ulrich Mehnert; Doris Maier; Rainer Abel; Frank Röhrich; Norbert Weidner; Rüdiger Rupp; Alfons G Kessels; Lucas M Bachmann; Thomas M Kessler Journal: PLoS Med Date: 2016-06-21 Impact factor: 11.069