Department of Urology, Netherlands Rijnstate Hospital, Arnhem, the Netherlands.
Neuromodulation. 2013 Jan-Feb;16(1):25-33; discussion 33. doi: 10.1111/j.1525-1403.2012.00504.x. Epub 2012 Sep 17.
This systematic review aimed to determine the efficacy and effectiveness of percutaneous tibial nerve stimulation (PTNS) on symptoms of overactive bladder (OAB) and pelvic organ disorders, pain, adverse events (AEs), and quality of life (QoL).
A literature search was performed in September 2011 in the databases MEDLINE, CINAHL, and EMBASE. Hand searching of references was conducted. Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with adult patients were included.
Seven studies met the eligibility criteria. Five RCTs indicated improvement (range 36.7-80%) on OAB symptoms, frequency, urgency, nocturia, and incontinence. One CCT reported improvement (mean 15.7) in 53% of the subjects on fecal incontinence (FI) symptoms on an FI Questionnaire (range 0-20). One RCT showed more than 50% improvement on pain (40%) and symptom scores (66.6%) in chronic pelvic pain (CPP). Limitations are the small amount, overall low quality, and variety in outcome measures of included studies. Only minor AEs were reported. No meta-analysis was performed as a consequence of heterogeneous data.
This systematic review provides evidence for the efficacy of PTNS on symptoms, pain, and QoL measures of OAB, FI and category IIIB CP/CPP. Evidence of effectiveness was found on symptoms and QoL for OAB. The total amount of seven included studies, from which even the most favorable study has some potential bias, is too small to draw firm conclusions. Independent high quality RCTs are necessary to confirm and delineate the range of therapeutic effects of PTNS in this region. PTNS is a safe intervention.
本系统评价旨在确定经皮胫神经刺激（PTNS）治疗膀胱过度活动症（OAB）和盆腔器官疾病、疼痛、不良事件（AEs）和生活质量（QoL）症状的疗效和有效性。
2011 年 9 月，我们在 MEDLINE、CINAHL 和 EMBASE 数据库中进行了文献检索，并进行了参考文献的手工检索。仅纳入了纳入了成人患者的随机对照试验（RCTs）和对照临床试验（CCTs）。
有 7 项研究符合入选标准。5 项 RCT 表明 OAB 症状、频率、紧迫性、夜尿和失禁均有改善（范围 36.7-80%）。1 项 CCT 报告称，在 FI 问卷（范围 0-20）上，53%的 FI 症状（均值 15.7）得到改善。1 项 RCT 显示慢性盆腔痛（CPP）患者的疼痛（40%）和症状评分（66.6%）有超过 50%的改善。纳入研究的数量少、总体质量低、结果测量指标不同是存在的局限性。仅报告了轻微的 AEs。由于数据的异质性，未进行荟萃分析。
本系统评价为 PTNS 治疗 OAB、FI 和 IIIB 类 CP/CPP 的症状、疼痛和 QoL 指标的疗效提供了证据。在 OAB 的症状和 QoL 方面发现了有效性的证据。纳入的 7 项研究的总量很小，即使是最有利的研究也存在一些潜在的偏倚，因此无法得出确定的结论。需要独立的高质量 RCT 来确认和描述 PTNS 在该领域的治疗效果范围。PTNS 是一种安全的干预措施。
