Posterior tibial nerve stimulation for overactive bladder—techniques and efficacy

Transcutaneous tibial nerve stimulation (TTNS)

Posterior tibial nerve stimulation is given via two 50 mm × 50 mm electrode pads. The live pad is placed posterior and superior to the medial malleolus and the ground pad is placed approximately 10 cm cephalad to this. Continuous stimulation at a pulse width of 200 ls and a frequency of 10 Hz is used. The amplitude was set to produce a sensory stimulus in the ipsilateral foot, at an intensity tolerable to the patient. Stimulation is given for 30 min.

(Ramirez-Garcia I, Blanco-Ratto L, Kauffman S, Carralero-Martinez A, Sanchez E. Efficacy of transcutaneous stimulation of the posterior tibial nerve compared to percutaneous stimulation in idiopathic overactive bladder syndrome: randomized control trial. Neuro Urol. 2019;38:261–268. doi: 10.1002/nau.23843)

Conclusion:

Transcutaneous tibial nerve stimulation (TTNS)

TTNS is an alternative method of stimulating the posterior tibial nerve using a patch rather than a needle electrode. One study randomized women into three groups; group 1 had TTNS twice a week for 30 min for 12 weeks, group 2 received slow-release oxybutynin 10 once daily for 12 weeks and group 3 received both treatments [31]. All groups showed improvement in OAB symptoms and quality of life scores. However, the combined treatment was more effective than single treatment. In addition, TTNS alone or in association with oxybutynin demonstrated longer lasting results in terms of clinical symptom improvement and QoL.

Another prospective randomized trial assessed TTNS (n = 36) versus extended release oxybutynin (ERO) (n = 34) in OAB patients [32]. The regime involved TTNS twice a week for 30 min for 12 weeks or 10 mg ERO once daily. There was a statistically significant reduction in frequency, urgency episodes and UI episodes compared with baseline; however there was no significant difference between the two groups overall.

A recent study randomized 40 women with nocturia into two groups of weekly TTNS sessions compared with pelvic floor muscle training and behavioural therapy for a 12-week treatment period [33]. Both treatments resulted in an improvement in the quality of sleep with a reduction in the number of awakenings to urinate (45% in both groups reduced by 1).

TTNS seems to be as good as PTNS in terms of symptom improvement and may be an option for those patients who find needle insertion unacceptable.

Our DrPRx Pelvic floor muscle stimulation kit both contain external electrodes with protocols for Posterior Tibial Nerve Stimulation as well as tradition internal stimulation using a vaginal or rectal probe.

Vaginal Probe

Rectal probe