Efficacy of Tibial Nerve Stimulation in Neurogenic Lower Urinary Tract Dysfunction Among Patients with Multiple Sclerosis: A Systematic Review and Meta-analysis

Abstract

Objective: This study was performed to systematically review the current literature on the effects of transcutaneous tibial nerve stimulation and percutaneous tibial nerve stimulation on multiple sclerosis-induced neurogenic lower urinary tract dysfunction. Materials and methods: Medical databases including PubMed, Scopus, Embase, and Web of Science were systematically searched from inception to September 2022. Meta-analysis was carried out using the comprehensive meta-analysis tool. Results: Our inclusion criteria were met by 12 studies evaluating the effects of percutaneous tibial nerve stimulation/transcutaneous tibial nerve stimulation on multiple sclerosis-induced neurogenic lower urinary tract dysfunction. Comparing the post-intervention results to the baseline showed that the rate of frequency was decreased in both percutaneous tibial nerve stimulation and transcutaneous tibial nerve stimulation groups after intervention. The overall mean change of tibial nerve stimulation on frequency was –2.623 (95% CI: –3.58, –1.66; P < .001, I 2 : 87.04) among 6 eligible studies. The post-void residual was decreased after treatment in both methods of tibial nerve stimulation, with an overall mean difference of –31.13 mL (95% CI: –50.62, –11.63; P = .002, I 2 : 71.81). The other urinary parameters, including urgency (mean difference: –4.69; 95% CI: –7.64, –1.74; P < .001, I 2 : 92.16), maximum cystometric capacity (mean difference: 70.95; 95% CI: 44.69, 97.21; P < .001, I 2 : 89.04), and nocturia (mean difference: –1.41; 95% CI: –2.22, 0.60; P < .001, I 2 : 95.15), were improved after intervention, too. However, the results of subgroup analysis showed no effect of transcutaneous tibial nerve stimulation on urinary incontinence (mean difference: –2.00; 95% CI: –4.06, 0.06; P = .057, I 2 : 95.22) and nocturia (mean difference: –0.39; 95% CI: –1.15, 0.37; P = .315, I 2 : 84.01). In terms of mean voided volume, the evidence was related to only percutaneous tibial nerve stimulation with a mean change of 75.01 mL (95% CI: –39.40, 110.61; P < .001, I 2 : 85.04). Conclusion: Although the current literature suggests that tibial nerve electrostimulation might be an effective method for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and derived from small, mostly nonrandomized trials with a high risk of bias and confounding.

Effects of posterior tibial nerve stimulation (PTNS) on lower urinary tract dysfunction: An umbrella review

“…Screening the titles and abstracts, left us with 76 studies which were selected for full‐text screening. Finally, 20 SRs met all the inclusion criteria and entered the study 16–35 . The PRISMA flow diagram of the literature search and results is shown in Figure 1.…”

“…From a total of 20 SRs, 13 of them conducted meta‐analysis 16,17,19,20,23,24,27,29,31–35 . China was the leading origin of publication with five studies 16,31–34 .…”

“…China was the leading origin of publication with five studies 16,31–34 . After that, Iran 23,24,29 and the United Kingdom 19,20,30 both had three publications.…”

“…NLUTD was a prominent diagnosis among the studies 16,19,22,24,27 . In addition, several studies investigated the effects of PPTNS on a specific neurological pathology; multiple sclerosis (MS)‐induced LUTD was the subject of three SRs, 24,29 and one study included studies regarding TPTNS effects on the QoL in Parkinson's disease 16 …”

Effects of Tibial Nerve Electrical Stimulation on Bowel Dysfunction in Multiple Sclerosis: A Systematic Review

“…Electrical tibial nerve stimulation (TNS), a neuromodulation technique that includes stimulating the tibial nerve with electricity, alleviates urinary and erectile dysfunction by modulating the sacral roots. This method has been suggested as a promising, non-invasive, and safe method to elevate neurologically challenged conditions, including MS. 11,12 With slight changes in technique, some methods fall under this category, including transcutaneous tibial nerve stimulation (TTNS) and percutaneous tibial nerve stimulation (PTNS). However, they are both based Int J Drug Res Clin, 2023, Volume 1 2 on delivering electrical impulses to the tibial nerve.…”