Urology Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
Mult Scler Relat Disord. 2022 Feb;58:103392. doi: 10.1016/j.msard.2021.103392. Epub 2021 Nov 10.
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.
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.
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 (95%CI:-0.93, -0.56)(I=0, p = 0.67). The pooled SMD of voiding volume (post-treatment - pre-treatment) was 1.21 (95% CI:0.94-1.49) (I:0%, p = 0.4). The pooled SMD of nocturia (post-treatment - pre-treatment) was -1.10 (95% CI:-1.33, -0.87) (I: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) (I:84.3%, p<0.001). The pooled frequency of responders was 66%(95% CI:59%-73%)(I:0).
The results of this systematic review and meta-analysis show that PTNS in effective in treating LUTS in patients with MS.
下尿路症状（LUTS）在多发性硬化症（MS）患者中很常见。经皮胫后神经刺激（PTNS）是一种微创治疗方法，被认为对患有 LUTS 症状的患者有效。在以前的研究中，报告的治疗终点不同。因此，我们设计了这项系统评价和荟萃分析，以根据不同的评估方法估计 PTNS 的汇总疗效。
我们系统地检索了 PubMed、Scopus、EMBASE、Web of Science 和谷歌学术。我们还检索了灰色文献，包括纳入研究的参考文献和会议摘要，这些摘要截至 2021 年 5 月发表。搜索策略包括 MeSH 和文本词，如（（胫骨神经）或胫后神经或（胫后神经）或（足底内侧神经）或（足底内侧神经）或（胫骨神经刺激）或（经皮胫骨神经刺激）或（经皮胫后神经刺激）或（皮神经刺激）和（多发性硬化症或多发性硬化症，多发性）或（多发性硬化症）或（播散性硬化症）或（播散性硬化症）或 MS（多发性硬化症））或多发性硬化症，急性爆发性。两名独立的研究人员独立评估了这些文章。
我们通过文献搜索发现了 2430 篇文章，删除重复项后还剩 2027 篇。有 8 篇文章进行了荟萃分析。排尿后残余量（PVR）（治疗后-治疗前）的合并 SMD 为-0.75（95%CI：-0.93，-0.56）（I=0，p=0.67）。排尿量（治疗后-治疗前）的合并 SMD 为 1.21（95%CI：0.94-1.49）（I：0%，p=0.4）。夜间尿频（治疗后-治疗前）的合并 SMD 为-1.10（95%CI：-1.33，-0.87）（I：86.4%，p<0.001）。每天漏尿量（治疗后-治疗前）的合并 SMD 为-0.69（95%CI：-0.93，-0.45）（I：84.3%，p<0.001）。应答者的合并频率为 66%（95%CI：59%-73%）（I：0）。
这项系统评价和荟萃分析的结果表明，PTNS 治疗多发性硬化症患者的 LUTS 是有效的。
