Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature

Manuela Tutolo; Enrico Ammirati; John Heesakkers; Thomas M Kessler; Kenneth M Peters; Tina Rashid; Karl-Dietrich Sievert; Michele Spinelli; Giacomo Novara; Frank Van der Aa; Dirk De Ridder

doi:10.1016/j.eururo.2017.11.002

Efficacy and Safety of Sacral and Percutaneous Tibial Neuromodulation in Non-neurogenic Lower Urinary Tract Dysfunction and Chronic Pelvic Pain: A Systematic Review of the Literature

Eur Urol. 2018 Mar;73(3):406-418. doi: 10.1016/j.eururo.2017.11.002. Epub 2018 Jan 12.

Authors

Affiliations

¹ Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: tutolo.manuela83@gmail.com.
² Department of Urology, Ospedale San Giovanni Battista, Turin, Italy.
³ Department of Urology 610, Radboud University Medical Center, Nijmegen, The Netherlands.
⁴ Department of Neuro-Urology, Balgrist University Hospital, Zurich, Switzerland.
⁵ Department of Urology, Beaumont Hospital, Royal Oak, MI, USA.
⁶ Functional Urology and Gender Services, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
⁷ University of Rostock Urology Clinic, Rostock, Germany; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria.
⁸ Spinal Unit, Division of Neurourology, A. Zanollo Center for Sacral Area Disfunction, Ospedale Niguarda, Milan, Italy.
⁹ Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy.
¹⁰ Department of Urology, University Hospitals Leuven, Leuven, Belgium.

PMID: 29336927
DOI: 10.1016/j.eururo.2017.11.002

Abstract

Context: Neuromodulation is considered in patients with non-neurogenic lower urinary tract dysfunction (LUTD) not responsive to conservative treatment.

Objective: To systematically review the available studies on efficacy and safety of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in non-neurogenic LUTDs not responsive to conservative treatments.

Evidence acquisition: A literature research was conducted in PubMed/Medline and Scopus, restricted to articles in English, published between January 1998 and June 2017, with at least 20 patients and 6 mo of follow-up.

Evidence synthesis: Twenty-one reports were identified. Concerning SNM, the improvement of ≥50% in leakage episodes ranged widely between 29% and 76%. Overall dry rate ranged between 43% and 56%. Overall success/improvement rate in PTNS varied between 54% and 59%. Symptom improvement or efficacy in interstitial cystitis/bladder pain syndrome patients appeared to be lower compared with other indications in both techniques. Safety data showed fewer side effects in patients submitted to PTNS.

Conclusions: Neuromodulation gives good results and is a safe therapy for patients with overactive bladder or chronic nonobstructive urinary retention with long-lasting efficacy. Moreover, PTNS has been shown to have good success rates and fewer side effects compared with SNM. These data have to be confirmed with long-term follow-up.

Patient summary: Sacral neuromodulation can improve low urinary tract symptoms in selected patients; it appears to be a safe therapy for nonresponders to standard medical therapies. Percutaneous tibial nerve stimulation (PTNS) is a less invasive technique that gives good results in short time with fewer side effects. However, we must consider that PTNS has not been tested in the long term and results are lower if compared with SNM.

Keywords: Chronic non-obstructive urinary retention; Lower urinary tract dysfunction; Overactive bladder; Sacral neuromodulation; Tibial nerve stimulation.

Publication types

Review