Posterior Tibial Nerve Stimulation

  • Gillian Frances Wolff
  • Ryan M. KrlinEmail author


Percutaneous Tibial Nerve Stimulation (PTNS) is a lower urinary tract neuromodulation technique involving the intermittent, weekly stimulation of the tibial nerve at the ankle. PTNS is a minimally invasive technique that requires no permanent lead or implanted stimulator. It is currently approved by the United States Food and Drug Administration (FDA) for the treatment of overactive bladder (OAB) and its associated frequency, urgency, and urgency urinary incontinence, but its uses in other clinical contexts are still under investigation.


  1. 1.
    Sanford MT, Suskind AM. Neuromodulation in neurogenic bladder. Transl Androl Urol. 2016;5(1):117–26.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Gaziev G, Topazio L, Iacovelli V, Asimakopoulos A, Di Santo A, De Nunzio C, et al. Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review. BMC Urol. 2013;13:61. Scholar
  3. 3.
    McGuire EJ, Zhang SC, Horwinski ER, Lytton B. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol. 1983;129(1):78–9.CrossRefGoogle Scholar
  4. 4.
    Vodusek D, Light J, Libby J. Detrusor inhibition induced by stimulation of pudendal nerve afferents. Neurourol Urodyn. 1986;5:381–9.CrossRefGoogle Scholar
  5. 5.
    Tai C, Shen B, Chen M, Wang J, Roppolo JR, de Groat WC. Prolonged poststimulation inhibition of bladder activity induced by tibial nerve stimulation in cats. Am J Physiol Renal Physiol. 2011;300(2):F385–92.CrossRefGoogle Scholar
  6. 6.
    Vandoninck V, van Balken MR, Finazzi Agro E, Petta F, Micali F, Heesakkers JP, et al. Percutaneous tibial nerve stimulation in the treatment of overactive bladder: urodynamic data. Neurourol Urodyn. 2003;22(3):227–32.CrossRefGoogle Scholar
  7. 7.
    Nguyen LN, Chowdhury ML, Gilleran JP. Outcomes for intermittent neuromodulation as a treatment for overactive bladder. Curr Bladder Dysfunct Rep. 2017;12(1):66–73.CrossRefGoogle Scholar
  8. 8.
    Finazzi Agro E, Campagna A, Sciobica F, Petta F, Germani S, Zuccala A, et al. Posterior tibial nerve stimulation: is the once-a-week protocol the best option? Minerva Urol Nefrol. 2005;57(2):119–23.PubMedGoogle Scholar
  9. 9.
    Yoong W, Ridout AE, Damodaram M, Dadswell R. Neuromodulative treatment with percutaneous tibial nerve stimulation for intractable detrusor instability: outcomes following a shortened 6-week protocol. BJU Int. 2010;106(11):1673–6.CrossRefGoogle Scholar
  10. 10.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.PubMedGoogle Scholar
  11. 11.
    Gormley EA, Lightner DJ, Faraday M, Vasavada SP. American Urological Association, Society of Urodynamics, Female Pelvic Medicine. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193(5):1572–80.CrossRefGoogle Scholar
  12. 12.
    Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56(5):766–71.CrossRefGoogle Scholar
  13. 13.
    Peters KM, Macdiarmid SA, Wooldridge LS, Leong FC, Shobeiri SA, Rovner ES, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055–61.CrossRefGoogle Scholar
  14. 14.
    Peters KM, Carrico DJ, Perez-Marrero RA, Khan AU, Wooldridge LS, Davis GL, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438–43.CrossRefGoogle Scholar
  15. 15.
    van der Pal F, van Balken MR, Heesakkers JP, Debruyne FM, Bemelmans BL. Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary? BJU Int. 2006;97(3):547–50.CrossRefGoogle Scholar
  16. 16.
    Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189(6):2194–201.CrossRefGoogle Scholar
  17. 17.
    MacDiarmid SA, Peters KM, Shobeiri SA, Wooldridge LS, Rovner ES, Leong FC, et al. Long-term durability of percutaneous tibial nerve stimulation for the treatment of overactive bladder. J Urol. 2010;183(1):234–40.CrossRefGoogle Scholar
  18. 18.
    Kessler TM, La Framboise D, Trelle S, Fowler CJ, Kiss G, Pannek J, et al. Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis. Eur Urol. 2010;58(6):865–74.CrossRefGoogle Scholar
  19. 19.
    Gobbi C, Digesu GA, Khullar V, El Neil S, Caccia G, Zecca C. Percutaneous posterior tibial nerve stimulation as an effective treatment of refractory lower urinary tract symptoms in patients with multiple sclerosis: preliminary data from a multicentre, prospective, open label trial. Mult Scler. 2011;17(12):1514–9.CrossRefGoogle Scholar
  20. 20.
    de Seze M, Raibaut P, Gallien P, Even-Schneider A, Denys P, Bonniaud V, et al. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Neurourol Urodyn. 2011;30(3):306–11.CrossRefGoogle Scholar
  21. 21.
    Ohannessian A, Kabore FA, Agostini A, Lenne Aurier K, Witjas T, Azulay JP, et al. Transcutaneous tibial nerve stimulation in the overactive bladder syndrome in patients with Parkinson’s syndromes. Prog Urol. 2013;23(11):936–9.CrossRefGoogle Scholar
  22. 22.
    Krivoborodov GG, Gekht AB, Korshunova ES. Tibial neuromodulation in the treatment of neurogenic detrusor hyperactivity in patients with Parkinson’s disease. Urologiia. 2006;(4):3–6.Google Scholar
  23. 23.
    Monteiro ES, de Carvalho LB, Fukujima MM, Lora MI, do Prado GF. Electrical stimulation of the posterior tibialis nerve improves symptoms of poststroke neurogenic overactive bladder in men: a randomized controlled trial. Urology. 2014;84(3):509–14.CrossRefGoogle Scholar
  24. 24.
    Chen G, Liao L, Li Y. The possible role of percutaneous tibial nerve stimulation using adhesive skin surface electrodes in patients with neurogenic detrusor overactivity secondary to spinal cord injury. Int Urol Nephrol. 2015;47(3):451–5.CrossRefGoogle Scholar
  25. 25.
    Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015;58(7):623–36.CrossRefGoogle Scholar
  26. 26.
    Horrocks EJ, Thin N, Thaha MA, Taylor SJ, Norton C, Knowles CH. Systematic review of tibial nerve stimulation to treat faecal incontinence. Br J Surg. 2014;101(5):457–68.CrossRefGoogle Scholar
  27. 27.
    Knowles CH, Horrocks EJ, Bremner SA, Stevens N, Norton C, O'Connell PR, et al. Percutaneous tibial nerve stimulation versus sham electrical stimulation for the treatment of faecal incontinence in adults (CONFIDeNT): a double-blind, multicentre, pragmatic, parallel-group, randomised controlled trial. Lancet. 2015;386(10004):1640–8.CrossRefGoogle Scholar
  28. 28.
    Rushton DN. Electrical stimulation in the treatment of pain. Disabil Rehabil. 2002;24(8):407–15.CrossRefGoogle Scholar
  29. 29.
    Zhao J, Nordling J. Posterior tibial nerve stimulation in patients with intractable interstitial cystitis. BJU Int. 2004;94(1):101–4.CrossRefGoogle Scholar
  30. 30.
    Ragab MM, Tawfik AM, Abo El-enen M, Elnady M, El-Gamal OM, El-Kordy M, et al. Evaluation of percutaneous tibial nerve stimulation for treatment of refractory painful bladder syndrome. Urology. 2015;86(4):707–11.CrossRefGoogle Scholar
  31. 31.
    Kabay S, Kabay SC, Yucel M, Ozden H. Efficiency of posterior tibial nerve stimulation in category IIIB chronic prostatitis/chronic pelvic pain: a Sham-Controlled Comparative Study. Urol Int. 2009;83(1):33–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of UrologyAlbany Medical CenterAlbanyUSA
  2. 2.Department of Urology, Lousiana State University Health Sciences CenterNew OrleansUSA

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