Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil.
Physical Therapy Department, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil.
Int Urogynecol J. 2022 May;33(5):1045-1058. doi: 10.1007/s00192-022-05088-7. Epub 2022 Feb 4.
Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder.
A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement.
Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week.
There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.
电神经刺激是治疗膀胱过度活动症的一种广泛应用的方法，但对于电极的最佳放置位置或方案尚未达成共识。我们假设，与其他方案相比，一些非植入性神经刺激方案在治疗非神经性膀胱过度活动症患者的尿路症状和提高生活质量方面将更为有效。
我们在五个电子数据库（PubMed/MEDLINE、Lilacs、CINAHL、Web of Science 和 PEDro）中进行了系统评价和随机临床试验的荟萃分析。主要结局是尿路症状-频率、夜尿症和紧迫性，次要结局是生活质量。提取了一些方案特征，例如频率、脉冲宽度、强度、干预时间和电极放置。
纳入了 9 项随机对照试验。胫骨神经刺激在急迫性尿失禁方面的效果优于骶神经刺激（平均差异=1.25 次，95%CI，0.12-2.38，n=73）。在汇总分析中，不同的神经刺激方案-阴道内、经皮胫骨和经皮胫骨神经刺激-在尿频率、夜尿症和紧迫性以及生活质量方面显示出相似的结果。总的来说，荟萃分析的效应大小为低至中度。经皮胫骨神经刺激的最佳报告参数为 20Hz 频率和 200μs 宽度，每周一次。
有证据表明，在非神经性膀胱过度活动症患者中，胫骨神经刺激在急迫性尿失禁症状方面比骶神经刺激更有效。总体而言，就尿路症状和生活质量而言，没有一种电神经刺激电极放置和方案比其他方案具有优势。需要进一步开展三臂试验的研究。本研究已在 PROSPERO 注册：CRD4201810071。
