Pediatric Posterior Tibial Nerve Stimulation

Chapter

Abstract

Non-neurogenic lower urinary tract dysfunction (LUTD) is common throughout the pediatric population, with nearly 40% of pediatric urology visits being related to voiding dysfunction. Conventional treatment options include management of constipation, behavioral therapy (i.e., bladder training, pelvic floor exercises, biofeedback), and/or medical therapy (i.e., anticholinergics, alpha-blockers). Roughly 20% of patients will be refractory to these conventional therapies. As a result, unconventional methods such as neuromodulation, including posterior tibial nerve stimulation (PTNS), have been proposed as a treatment option. PTNS is FDA approved and has been well studied in the adult population and has recently become a target of interest for the management of pediatric voiding dysfunction.

PTNS can be performed in either a percutaneous or transcutaneous approach. Percutaneous PTNS involves needle stimulation of the tibial nerve about 2 cm cephalad to the medial malleolus. Multiple studies have shown that this approach is effective in significantly improving symptoms of urgency, incontinence, normalizing voiding frequency, and improving urodynamic measures. The transcutaneous approach eliminates the use of a needle and instead uses adhesive electrodes to stimulate the tibial nerve. This approach has also been shown to significantly improve LUTD symptoms, as well as improve urodynamic measures. PTNS has emerged as a safe and noninvasive option that should be included in the discussion of pediatric patients suffering from refractory voiding dysfunction.

Keywords

Posterior tibial nerve stimulation Neuromodulation Lower urinary tract dysfunction Urgency Frequency Nocturia Overactive bladder Enuresis Percutaneous Transcutaneous 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyBeaumont Hospital/Oakland University William Beaumont School of MedicineRoyal OakUSA

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