Percutaneous posterior tibial nerve stimulation (PTNS) for lower urinary tract symptoms (LUTSs) treatment in patients with multiple sclerosis (MS): A systematic review and meta-analysis

Abstract

Background: Lower urinary tract symptoms (LUTSs) are common in patients with multiple sclerosis (MS). Percutaneous posterior tibial nerve stimulation (PTNS) is a minimally invasive treatment which is considered to be effective for patients who suffer from LUTS symptoms. In previous studies, the endpoints of treatment reported differently. So, we designed this systematic review and meta-analysis to estimate pooled efficacy of PTNS based on different assessment methods. Methods: We systematically searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. We also searched the gray literature including references of the included studies, and conference abstracts which were published up to May 2021. The search strategy included the MeSH and text words as (((Tibial Nerves) OR Posterior Tibial Nerve) OR (Posterior Tibial Nerves) OR (Medial Plantar Nerves) OR (Medial Plantar Nerve) OR (tibial Nerve Stimulation) OR (Trans-Cutaneous Tibial Nerve Stimulation) OR (Percutaneous Tibial Nerve Stimulation) OR (Cutaneous Tibial Nerve Stimulation) AND ((Multiple Sclerosis OR Sclerosis, Multiple) OR Sclerosis, Disseminated) OR Disseminated Sclerosis) OR MS (Multiple Sclerosis)) OR Multiple Sclerosis, Acute Fulminating).Two independent researchers independently evaluated the articles. Results: We found 2430 articles by literature search, after deleting duplicates 2027 remained. Eight articles remained for meta-analysis The pooled SMD of post voiding residual (PVR) (post-treatment - pre-treatment) was-0.75 (95CI:-0.93,-0.56) (I2=0, p = 0.67). The pooled SMD of voiding volume (post-treatment - pre-treatment) was 1.21 (95 CI:0.94-1.49) (I2:0, p = 0.4). The pooled SMD of nocturia (post-treatment - pre-treatment) was-1.10 (95 CI:-1.33,-0.87) (I2:86.4, p < 0.001). The pooled SMD of leakage per day (post-treatment - pre-treatment) was-0.69 (95 CI:-0.93,-0.45) (I2:84.3, p < 0.001). The pooled frequency of responders was 66(95 CI:59-73)(I-2:0). Conclusion: The results of this systematic review and meta-analysis show that PTNS in effective in treating LUTS in patients with MS.