Application of Posterior Tibial Nerve Stimulation (PTNS) in Reducing the Symptoms of Painful Bladder Syndrome: A Systematic Review

Abstract

Introduction: Painful bladder syndrome is known as a chronic and progressive bladder disorder. The present systematic review was performed with aim to investigate the method of posterior tibial nerve stimulation (PTNS) in the treatment of painful bladder syndrome. Methods: This systematic review study was conducted using Persian and English keywords and all their possible combinations in PubMed, Scopus, ProQuest, Google scholar, Web of science, The Cochrane Library, EMBASE, Cinhal, SID, Magiran, IranMedex and IranDoc databases without time and language limitation until April 2022. Two authors independently identified, screened and qualitatively reviewed the articles and extracted data. Results: Using the search strategy, 317 studies were retrieved. Seven studies with 174 samples were included in the present systematic review and among them 5 articles were eligible for meta-analysis. The findings showed that needle stimulation of the posterior tibial nerve caused a significant improvement and reduction in the mean frequency of nocturnal urination (mean difference: -0.78, 95% confidence interval: -0.15 to -1.41) and daily urination frequency (mean difference: -3.94, 95% confidence interval: -1.43 to -6.44) compared to the values before treatment. Also, although the values related to interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) also decreased after the intervention compared to the values before treatment, based on the random effects model, this mean difference was not statistically significant. Conclusion: The results of the present study showed the effect of needle stimulation of the posterior tibial nerve on the mean frequency of daily urination and nighttime urination, however, due to the heterogeneity of the studies and the absence of a control arm, it is not possible to definitely determine a standard method for stimulation of the posterior tibial nerve. Therefore, it is recommended to conduct randomized clinical trials with a larger sample size.

Keywords

• interstitial cystitis
• painful bladder syndrome
• posterior tibial nerve stimulation
• systematic review
• tibial nerve