Tibial Nerve Stimulation for Voiding Dysfunction

This presentation details the evolution and clinical applications of Percutaneous Tibial Nerve Stimulation (PTNS) as a minimally invasive therapy for a range of bladder dysfunctions. Building upon the foundational work of McGuire et al. in 1983, who demonstrated that transcutaneous stimulation of the common peroneal or posterior tibial nerve could alleviate lower urinary tract symptoms (LUTS), Professor Stoller introduced a refined percutaneous technique in 1990, termed Stoller Afferent Nerve Stimulation (SANS). This method specifically targets the posterior tibial nerve to treat overactive bladder (OAB) syndrome.

Clinical results from an early cohort of 90 patients showed that 80% experienced at least a 50% reduction in symptoms, establishing PTNS as a promising alternative to pharmacologic or more invasive therapies. Over time, PTNS has been successfully applied to various bladder conditions, including neurogenic bladder, non-obstructive urinary retention (NOUR), pediatric voiding dysfunction, and chronic pelvic pain/painful bladder syndrome (CPP/PBS).

A systematic review of published studies on PTNS reports broad effectiveness across patient populations:

• 37–100% symptom improvement in OAB patients
• 41–100% effectiveness in NOUR patients
• Up to 100% response rate in CPP/PBS and pediatric dysfunction cases

These findings underscore PTNS as a safe, effective, and non-pharmacological option for bladder control, although additional research is needed to confirm its long-term efficacy and expand its indications.

Professor Stoller will also highlight Tensi+, a state-of-the-art device developed by Stimuli Technology. Tensi+ employs transcutaneous electrical nerve stimulation (TENS) to activate the posterior tibial nerve non-invasively. The device is designed for daily 20-minute treatments over a minimum of 12 weeks, with some patients experiencing symptom relief as early as six weeks. Clinical studies from Europe and Canada validate Tensi+ for its safety and efficacy, making it an accessible, patient-friendly solution for managing OAB and related voiding dysfunctions.

This presentation will provide insights into PTNS’s clinical development, treatment protocols, and emerging technologies like Tensi+, offering valuable knowledge for clinicians and researchers focused on improving bladder dysfunction management.