Elsevier

European Urology

Volume 69, Issue 6, June 2016, Pages 1102-1111
European Urology

Guidelines
Transcutaneous Electrical Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

https://doi.org/10.1016/j.eururo.2016.01.010Get rights and content

Abstract

Context

Transcutaneous electrical nerve stimulation (TENS) is a promising therapy for non-neurogenic lower urinary tract dysfunction and might also be a valuable option in patients with an underlying neurological disorder.

Objective

We systematically reviewed all available evidence on the efficacy and safety of TENS for treating neurogenic lower urinary tract dysfunction.

Evidence acquisition

The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

Evidence synthesis

After screening 1943 articles, 22 studies (two randomised controlled trials, 14 prospective cohort studies, five retrospective case series, and one case report) enrolling 450 patients were included. Eleven studies reported on acute TENS and 11 on chronic TENS. In acute TENS and chronic TENS, the mean increase of maximum cystometric capacity ranged from 69 ml to 163 ml and from 4 ml to 156 ml, the mean change of bladder volume at first detrusor overactivity from a decrease of 13 ml to an increase of 175 ml and from an increase of 10 ml to 120 ml, a mean decrease of maximum detrusor pressure at first detrusor overactivity from 18 cmH20 to 72 cmH20 and 8 cmH20, and a mean decrease of maximum storage detrusor pressure from 20 cmH20 to 58 cmH2O and from 3 cmH20 to 8 cmH2O, respectively. In chronic TENS, a mean decrease in the number of voids and leakages per 24 h ranged from 1 to 3 and from 0 to 4, a mean increase of maximum flow rate from 2 ml/s to 7 ml/s, and a mean change of postvoid residual from an increase of 26 ml to a decrease of 85 ml. No TENS-related serious adverse events have been reported. Risk of bias and confounding was high in most studies.

Conclusions

Although preliminary data suggest TENS might be effective and safe for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and more reliable data from well-designed randomised controlled trials are needed to make definitive conclusions.

Patient summary

Early data suggest that transcutaneous electrical nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required.

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.

References (37)

  • L.A. Simpson et al.

    The health and life priorities of individuals with spinal cord injury: a systematic review

    J Neurotrauma

    (2012)
  • T. Sundin et al.

    Detrusor inhibition induced from mechanical stimulation of the anal region and from electrical stimulation of pudendal nerve afferents. An experimental study in cats

    Invest Urol

    (1974)
  • C. Ozkul et al.

    Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial

    J Back Musculoskelet Rehabil

    (2015)
  • M.P. Schneider et al.

    Refractory chronic pelvic pain syndrome in men: can transcutaneous electrical nerve stimulation help?

    BJU Int

    (2013)
  • J. Bartley et al.

    Neuromodulation for overactive bladder

    Nat Rev Urol

    (2013)
  • M. Tellenbach et al.

    Transcutaneous electrical nerve stimulation: an effective treatment for refractory non-neurogenic overactive bladder syndrome?

    World J Urol

    (2013)
  • D. Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    Ann Intern Med

    (2009)
  • Viswanathan M, Ansari MT, Berkman ND, et al. Assessing the risk of bias of individual studies in systematic reviews of...
  • Cited by (0)

    These authors contributed equally and share the first authorship.

    View full text