Influence of transcutaneous tibial nerve stimulation on postoperative catheter-related bladder discomfort in urology: a prospective randomized controlled trial

Male patients undergoing urologic surgery under general anesthesia are more prone to developing catheter-related bladder discomfort (CRBD). Transcutaneous tibial nerve stimulation (TTNS) is an established intervention for lower urinary tract dysfunction. This study aimed to evaluate the impact of TTNS on the incidence of moderate-to-severe CRBD in male patients following urological surgery under general anesthesia. 124 male patients scheduled for urologic surgery from December 2023 to June 2024 were included and randomized to the TTNS or Control groups via stratified block group randomization. The TTNS group received 30 min of TTNS stimulation (200-μs pulses, 20/100 Hz alternating sparse-dense waves) in the post-anesthesia care unit, while the Control group received 30 min of sham stimulation. The degree of CRBD and VAS scores at 0 h, 1 h, 2 h, and 6 h after tracheal extubation, the Quality of Recovery-15 (QoR-15) score at 24 h postoperatively, length of hospitalization, rescue medication rates, and the incidence of adverse reactions were compared between the two groups. Compared with the Control group, a significant reduction was observed in the incidence of moderate-to-severe CRBD immediately after tracheal extubation (0 h) in the TTNS group [P = 0.002, CI 0.190-0.741, RR 0.375]. The incidence of moderate-to-severe CRBD in the TTNS group was significantly lower than that in the Control group at 1 and 2 h after extubation (P < 0.001, P = 0.002). Furthermore, the severity of CRBD at all time points was significantly lower than that in the TTNS group (P = 0.017, P < 0.001, P < 0.001, and P < 0.001, respectively). The VAS scores of patients in the TTNS group were notably lower than those in the Control group at 0, 1, and 2 h after tracheal extubation (P = 0.009, P = 0.012, P = 0.013, respectively). The QoR-15 scores at 24 h post-surgery in the TTNS group were significantly higher (P < 0.001). The incidence rates of postoperative nausea and medication rescue were lower in the TTNS group than in the Control group (P = 0.006, P < 0.001). Finally, the TTNS intervention was not associated with any adverse effects. TTNS effectively reduces the incidence of moderate-to-severe CRBD, enhances early postoperative analgesia, and improves recovery quality in male patients undergoing urologic surgery without significant safety concerns.Trial registration: This study was retrospectively registered and reviewed by a principal investigator (Xiangying Zheng) in the Chinese Clinical Trials Registry (registration number: ChiCTR2300078536) on December 12, 2023.