GuidelinesTranscutaneous Electrical Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review
Introduction
Lower urinary tract dysfunction is common in neurological patients resulting in symptoms that have a pronounced effect on quality of life [1]. The site and nature of the neurological lesion determines the pattern of dysfunction [1], [2]. The high prevalence of neurogenic lower urinary tract dysfunction (NLUTD) is reflected by the wide distribution of neural control in health and depends on the underlying neurological disorder, for instance reaching about 25% in patients with Alzheimer‘s disease and approaching 100% in those suffering from multiple sclerosis at an advanced stage [1], [2]. NLUTD substantially impairs quality of life and lower urinary tract function becomes one of the most relevant aspects in daily life of the neuro-urological patient [1], [3]. Optimal treatment of storage and/or voiding symptoms is a main challenge in this population, especially because conventional treatments often fail.
In 1974, Sundin et al [4] showed for the first time that electrical pudendal stimulation resulted in the inhibition of bladder contraction in cats. This technique was improved, extended to different stimulation sites, and is now used as transcutaneous electrical nerve stimulation (TENS) for the treatment of various urological dysfunctions. Electrical stimulation is applied continuously or is event driven. TENS is reported to be a potent and safe treatment option, both in patients suffering from chronic pelvic pain [5], [6] and non-neurogenic overactive bladder syndrome [7], [8]. Positive treatment effects might also be expected in patients with an underlying neurological disorder. We therefore performed a systematic review to assess and appraise all available evidence on the efficacy and safety of TENS for treating NLUTD.
Section snippets
Data sources and searches
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement [9]. The protocol for the review is available on PROSPERO (CRD42014008678) (http://www.crd.york.ac.uk/PROSPERO). We systematically searched Embase, Medline, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database (from January 1, 1946 to January 23, 2015). No language or date restrictions were applied. We additionally searched the
Search results
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the literature search and results is shown in Figure 1. After screening 1943 abstracts, 22 studies were included in a narrative synthesis [11] (Table 1, Table 2, Table 3, Table 4; Fig. 2A–H): two RCTs [12], [13], 14 prospective cohort studies [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], five retrospective case series [28], [29], [30], [31], [32], and one case report [33].
Principal findings
The positive impact on urodynamic (maximum cystometric capacity, maximum detrusor pressure at first detrusor overactivity, maximum storage detrusor pressure, and maximum flow rate) and bladder diary (voids per 24 h, leakages per 24 h) parameters as well as the favourable adverse event profile, indicate that TENS might be effective and safe for treating NLUTD. This is underlined by the statistically significant differences between the treatment and control group in the RCT by Guo et al [12] for
Conclusions
Preliminary evidence indicates that TENS is an effective and safe treatment option for patients with NLUTD. However, quality of evidence was low, especially due to a lack of well-designed, appropriately sampled, and powered RCTs. This systematic review demonstrated the potential of TENS for treating NLUTD and identified the need for more reliable data in order to make definitive conclusions.
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These authors contributed equally and share the first authorship.