Health Problem: Also known as neurogenic bladder, neurogenic lower urinary tract dysfunction (nLUTD) is a condition in which an individual lacks bladder control due to a brain, spinal cord, or peripheral nervous system disease or injury. Disturbances of storage may result in lower urinary tract symptoms such as urinary urgency, urge urinary incontinence, urinary frequency, and nocturia—the components of overactive bladder syndrome. In patients with focal brain lesions, lesion location may correspond with LUTD. In patients with multiple sclerosis, Parkinson disease, and polyneuropathies, these dysfunctions progress as the disease progresses. The prevalence of nLUTD varies among patients with different neurological diseases or injuries, ranging from 15% to 90%.

Technology Description: Percutaneous tibibal nerve stimulation (PTNS) involves indirect modulation of the specific nerve that controls bladder function (i.e., the sacral nerve plexus) via stimulation of the posterior tibial nerve accessed just above the ankle. This minimally invasive form of neuromodulation consists of insertion of a needle electrode near the tibial nerve. Stimulation is administered at a current level of 0.5 to 9 milliamperes at 20 hertz and continues for 30 minutes. Initial treatment regimens typically consist of 12 weekly sessions, with responders exhibiting some symptom improvement after 6 to 8 sessions. Maintenance treatment sessions may be required to sustain the response to treatment. PTNS is typically used when patients are not responding adequately to conservative therapies.

Controversy: Response rates with PTNS vary, suggesting that not all patients respond to treatment, and patient selection criteria for PTNS are not well defined. Most responders require maintenance sessions to sustain the therapeutic effects of PTNS, but maintenance protocols vary and there is little evidence regarding the long-term effectiveness of this therapy beyond the initial 12-week treatment series. There are also remaining questions about the comparative effectiveness of PTNS and alternative treatments for nLUTD.

Key Questions:

For adult patients with neurological disease or injury:

  • Does PTNS improve symptoms of nLUTD that arise secondary to neurologic conditions?
  • Is PTNS safe?
  • Have definitive patient selection criteria for nLUTD been established for PTNS?

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