Efficacy and safety of percutaneous tibial nerve stimulation on the overactive bladder in multiple sclerosis: A systematic review and meta-analysis

Abstract

This study was performed to systematically review the current literature on the effects of transcutaneous tibial nerve stimulation (TTNS) and percutaneous tibial nerve stimulation (PTNS) on MS-induced neurogenic lower urinary tract dysfunction (NLUTD). Material and methods: Medical databases including Pubmed, Scopus, Embase, and Web of Science were systematically searched from inception to September 2022. Meta-analysis was carried out using the Comprehensive Meta-analysis (CMA) tool. Results: Our inclusion criteria were met by 12 studies evaluating the effects of PTNS/TTNS on MS-induced NLUTD. Comparing the post-intervention results to the baseline showed that the rate of frequency was decreased in both PTNS, and TTNS groups after intervention. The overall mean change of TNS on frequency was -2.623 (95% CI: -3.58, -1.66; P<0.001, I2:87.04) among six eligible studies. The post-void residual (PVR) was decreased after treatment in both methods of TNS, with an overall mean difference of -31.13 ml (95% CI: -50.62, -11.63; P=0.002, I2:71.81). The other urinary parameters including urgency (mean difference [MD]: -4.69; 95% CI: -7.64, 1.7; P<0.001, I2:92.16), maximum cystometric capacity (MCC) (MD: 70.95; 95% CI: 44.69, 97.21; P<0.001, I2:89.04), and nocturia (MD: -1.41; 95% CI: -2.22, 0.60; P<0.001, I2:95.15), were improved after intervention, too. However, the results of subgroup analysis showed no effect of TTNS, on urinary incontinence (MD: -2.00; 95% CI: -4.06, 0.06; P=0.057, I2:95.22), and nocturia (MD: -0.39; 95% CI: -1.15, 0.37; P=0.315, I2:84.01). In terms of mean voided volume (MVV), the evidence was related to only PTNS with a mean change of 75.01 ml (95% CI: -39.40, 110.61; P<0.001, I2:85.04).