The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review

Joanne Booth, Lesley Connelly, Sylvia Dickson, Fiona Duncan, Maggie Lawrence

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Abstract

Aims: To evaluate effectiveness of transcutaneous tibial nerve stimulation (TTNS)
for treating adults with overactive bladder (OAB) of idiopathic or neurogenic origin, using a systematic review of the literature.
Methods: Systematic searches of four databases were undertaken between 1980 and 2017. Included studies investigated effects of TTNS on OAB. Study selection, data extraction, quality appraisal was performed by two independent reviewers. Narrative analysis was undertaken where meta-analysis was not possible due to study heterogeneity. Meta-analysis of RCTs was performed using a fixed effects model.
Results: Ten RCTs and three prospective cohort studies involving 629 participants
were reviewed. Meta-analysis of two trials comparing TTNS with sham showed mean reduction in total ICIQ Urinary Incontinence Short Form (ICIQ-UI SF) associated with TTNS of -3.79 (95% CI -5.82, -1.76; P = 0.0003, I2 = 25%). Narrative review showed TTNS and antimuscarinic treatment were equally effective (four trials), TTNS provided greater benefit for OAB symptoms than behavioral interventions (two trials), tibial nerve, and sacral foramen stimulation were equally effective but combined stimulation was most effective (one trial). Significant improvements in OAB symptoms were reported by 48-93% participants and UI cure rates of 25-45%. No adverse events were reported.
Conclusions: Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups,most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.
Original languageEnglish
Pages (from-to)528-541
Number of pages14
JournalNeurourology and Urodynamics
Volume37
Issue number2
Early online date21 Jul 2017
DOIs
Publication statusPublished - Feb 2018

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Transcutaneous Electric Nerve Stimulation
Overactive Urinary Bladder
Tibial Nerve
Meta-Analysis
Neurogenic Urinary Bladder
Behavioral Symptoms
Muscarinic Antagonists
Urinary Incontinence
Cohort Studies
Databases
Prospective Studies
Costs and Cost Analysis

Keywords

  • neuromodulation, overactive, tibial nerve, transcutaneous electric nerve stimulation, urinary bladder

Cite this

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title = "The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review",
abstract = "Aims: To evaluate effectiveness of transcutaneous tibial nerve stimulation (TTNS)for treating adults with overactive bladder (OAB) of idiopathic or neurogenic origin, using a systematic review of the literature.Methods: Systematic searches of four databases were undertaken between 1980 and 2017. Included studies investigated effects of TTNS on OAB. Study selection, data extraction, quality appraisal was performed by two independent reviewers. Narrative analysis was undertaken where meta-analysis was not possible due to study heterogeneity. Meta-analysis of RCTs was performed using a fixed effects model.Results: Ten RCTs and three prospective cohort studies involving 629 participantswere reviewed. Meta-analysis of two trials comparing TTNS with sham showed mean reduction in total ICIQ Urinary Incontinence Short Form (ICIQ-UI SF) associated with TTNS of -3.79 (95{\%} CI -5.82, -1.76; P = 0.0003, I2 = 25{\%}). Narrative review showed TTNS and antimuscarinic treatment were equally effective (four trials), TTNS provided greater benefit for OAB symptoms than behavioral interventions (two trials), tibial nerve, and sacral foramen stimulation were equally effective but combined stimulation was most effective (one trial). Significant improvements in OAB symptoms were reported by 48-93{\%} participants and UI cure rates of 25-45{\%}. No adverse events were reported.Conclusions: Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups,most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.",
keywords = "neuromodulation, overactive, tibial nerve, transcutaneous electric nerve stimulation, urinary bladder",
author = "Joanne Booth and Lesley Connelly and Sylvia Dickson and Fiona Duncan and Maggie Lawrence",
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T1 - The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review

AU - Booth, Joanne

AU - Connelly, Lesley

AU - Dickson, Sylvia

AU - Duncan, Fiona

AU - Lawrence, Maggie

N1 - Acceptance date from journal webpage AAM: 12m

PY - 2018/2

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N2 - Aims: To evaluate effectiveness of transcutaneous tibial nerve stimulation (TTNS)for treating adults with overactive bladder (OAB) of idiopathic or neurogenic origin, using a systematic review of the literature.Methods: Systematic searches of four databases were undertaken between 1980 and 2017. Included studies investigated effects of TTNS on OAB. Study selection, data extraction, quality appraisal was performed by two independent reviewers. Narrative analysis was undertaken where meta-analysis was not possible due to study heterogeneity. Meta-analysis of RCTs was performed using a fixed effects model.Results: Ten RCTs and three prospective cohort studies involving 629 participantswere reviewed. Meta-analysis of two trials comparing TTNS with sham showed mean reduction in total ICIQ Urinary Incontinence Short Form (ICIQ-UI SF) associated with TTNS of -3.79 (95% CI -5.82, -1.76; P = 0.0003, I2 = 25%). Narrative review showed TTNS and antimuscarinic treatment were equally effective (four trials), TTNS provided greater benefit for OAB symptoms than behavioral interventions (two trials), tibial nerve, and sacral foramen stimulation were equally effective but combined stimulation was most effective (one trial). Significant improvements in OAB symptoms were reported by 48-93% participants and UI cure rates of 25-45%. No adverse events were reported.Conclusions: Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups,most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.

AB - Aims: To evaluate effectiveness of transcutaneous tibial nerve stimulation (TTNS)for treating adults with overactive bladder (OAB) of idiopathic or neurogenic origin, using a systematic review of the literature.Methods: Systematic searches of four databases were undertaken between 1980 and 2017. Included studies investigated effects of TTNS on OAB. Study selection, data extraction, quality appraisal was performed by two independent reviewers. Narrative analysis was undertaken where meta-analysis was not possible due to study heterogeneity. Meta-analysis of RCTs was performed using a fixed effects model.Results: Ten RCTs and three prospective cohort studies involving 629 participantswere reviewed. Meta-analysis of two trials comparing TTNS with sham showed mean reduction in total ICIQ Urinary Incontinence Short Form (ICIQ-UI SF) associated with TTNS of -3.79 (95% CI -5.82, -1.76; P = 0.0003, I2 = 25%). Narrative review showed TTNS and antimuscarinic treatment were equally effective (four trials), TTNS provided greater benefit for OAB symptoms than behavioral interventions (two trials), tibial nerve, and sacral foramen stimulation were equally effective but combined stimulation was most effective (one trial). Significant improvements in OAB symptoms were reported by 48-93% participants and UI cure rates of 25-45%. No adverse events were reported.Conclusions: Limited evidence is provided that TTNS is an effective, safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB. Further studies are essential to confirm these results as well as to determine efficacy and associated costs for specific patient groups,most effective stimulation dosage, duration of effect, and stimulation regimes for longer-term maintenance.

KW - neuromodulation, overactive, tibial nerve, transcutaneous electric nerve stimulation, urinary bladder

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SN - 0733-2467

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