The Efficacy of Posterior Tibial Nerve Stimulation in the Treatment of Lower Urinary Tract Disorders in Children: A Systematic Review

Background: Lower Urinary Tract Disorders (LUTDs) are frequently observed among the pediatric population. Posterior Tibial Nerve Stimulation (PTNS) is a form of neuromodulation that aims to alter the aberrant pattern of nerve stimulation that supplies innervation to the bladder and pelvic floor. The objective of this systematic review was to broaden the scope of investigation on PTNS and evaluate its efficacy in the management of LUTDs in children. Methods: A systematic search was conducted across seven electronic databases (Scopus, Web of Science, PubMed/MEDLINE, ProQuest, EMBASE, CENTRAL, PEDro) from inception to March 31, 2024, without any language restrictions. The search aimed to identify publications that compared the efficacy of PTNS with anticholinergic medications, urotherapy, sham, placebo, or other interventions for the treatment of LUTDs in children. The primary outcome was symptom improvement, and the secondary outcomes were urodynamic parameters and Quality of Life (QoL). The risk of bias was assessed using the Cochrane Collaboration’s tool. Results: This systematic review included a total of six clinical trial, comprising 203 children. Merely, single research exhibited an overall low risk of bias, while another one demonstrated an overall unclear risk of bias. The studies evaluated a range of symptoms using various assessment methods or tools and found that PTNS resulted in symptom improvement for different LUTDs. Both arms of the two studies evaluating QoL reported a noteworthy improvement. Moreover, a significant improvement in the majority of urodynamic parameters was reported with PTNS across the studies. Conclusion: The results of the included studies were in favor of PTNS for the treatment of LUTDs in children. Unified symptom assessment tools, standardized response to treatment criteria, a larger sample size, a lower risk of bias, a minimum number of urodynamic parameters, longer follow-ups, and the occurrence of adverse events should be considered for future clinical trials.