PERCUTANEOUS TIBIAL NEUROMODULATION FOR THE TREATMENT OF PELVIC PAIN AND URINARY DISORDERS: A PILOT CLINICAL OBSERVATION

Background. Tibial neuromodulation (TNM) is a physiotherapeutic treatment method initially developed for the management of overactive bladder. The therapeutic effect is achieved through stimulation of the posterior tibial nerve — a mixed sensorimotor nerve originating from the L4-S3 spinal roots. Since 2003, TNM has also been used in the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS) due to its analgesic effect. Purpose. To evaluate the clinical effectiveness of percutaneous tibial neuromodulation in patients with various urological disorders accompanied by pelvic pain, dysuric disorders, and/or bladder emptying dysfunction. Materials and methods. The study included 14 patients (12 women and 2 men). All participants underwent a course of percutaneous tibial neuromodulation, alongside pharmacological and/or surgical treatment depending on the primary diagnosis. Clinical parameters recorded included: sex, age, primary diagnosis, disease duration, presence of leukocyturia and bacteriuria in urine, and urine culture results. To assess clinical dynamics, the Visual Analog Scale (VAS) for pain and the Global Response Assessment (GRA) scale-from 1 (marked worsening) to 7 (marked improvement) were used. Results. The mean age of the patients was 52 ± 15.87 years. The average disease duration was 7 ± 8.25 years. The main diagnoses included chronic cystitis with myofascial pain, interstitial cystitis, chronic prostatitis with myofascial syndrome, and chronic pelvic pain syndrome. Urine culture revealed bacterial flora in 9 patients; 7 of them also had leukocyturia. The most frequently reported symptoms included suprapubic bladder pain, urethral pain or discomfort, urgency, a sensation of incomplete bladder emptying, perineal pain, and radiation of pain to the thighs or scrotum.Improvement was noted in 85.7% of patients: 5 reported significant improvement, 7 reported moderate improvement, and 2 showed no effect. The mean GRA score was 4.36 ± 0.63. Most patients continued TNM therapy on an outpatient basis. The duration of the treatment course ranged from 14 days to 2 months. Conclusions. Tibial neuromodulation may be an effective component of comprehensive therapy for chronic pelvic pain, dysuric symptoms, and voiding dysfunction. A positive trend on the GRA scale in 85.7% of cases confirms the efficacy of the method, which is well-tolerated and suitable for outpatient practice. Further studies are needed to clarify the indications, optimal course duration, and specific effects in various diagnostic groups.