Tibial nerve stimulation in the treatment of overactive bladder syndrome: technical features of latest applications

Abstract

Purpose of review Overactive bladder syndrome (OAB) is a chronic condition, which can be treated by tibial nerve stimulation. The present review will focus on the technical aspects, advantages, drawbacks, and limitations of the latest available applications of posterior tibial nerve stimulation. Recent findings We describe the technical aspects of recent developed implants and techniques of tibial nerve stimulation in a transcutaneous, percutaneous, and minimal invasive way. All different treatment options have advantages and disadvantages based on type of surgery, energy transfer, impedance, treatment setting options, risk of migration, and patient usability, which are described in this review. Only devices with data that are publicly available were included. Summary New technologies are on their way in the field of tibial nerve stimulation for the treatment of OAB. Technical aspects are important to demonstrate safety and efficacy and user friendliness in order to obtain high acceptance of the various devices.

Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines

“…Additionally, the system has a lower migration risk due to the implant's suture holes and size. The open surgery technique to implant this system is the main drawback compared to percutaneous PTNS and other injectable implants [ 35 ].…”

“…Passively, the lead transfers energy from the superficial end (near to the EPG) to the electrodes. As a result, the ideal amplitude is likely to be 5-10 times greater in everyday practice than during test stimulation at implantation time [ 35 ]. There are currently no published studies on this neuromodulation technology in the OAB field.…”

“…In this procedure, a patient receives an implanted stimulator with an embedded receiver through a 5 mm skin incision, and the energy supply for the implanted stimulator is a small, rechargeable transmitter worn by the patient. The external energy source is connected to external antennae and is worn close to the implant's internal antenna [ 35 ].…”

“…Fine needles are used to stimulate the Sanyinjiao point (SP-6), in which is located four fingers' breadth above the medial malleolus (SP-6). SP-6 is most likely to be the site of the tibial nerve that has been used to restore energetic harmony [ 35 ].…”

“…Surprisingly, no defined treatment protocol exists. Different regimens (3, 6, 8, and 12 weeks) are discussed [ 35 , 41 – 43 ]. The most often utilized percutaneous PTNS program involves weekly sessions lasting around 30 minutes for ten to twelve weeks [ 38 ].…”