Efficacy of percutaneous tibial nerve stimulation in pediatric bladder dysfunction: A systematic review and meta-analysis

Lower urinary tract symptoms (LUTS) impair quality of life in children. Percutaneous tibial nerve stimulation (PTNS), a non-invasive neuromodulation treatment has shown promise in the adult population. However, its efficacy in children has yet to be thoroughly investigated. A PRISMA-compliant systematic review and meta-analysis was conducted to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) in children with neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD). Relevant studies published up to March 2025 were identified through searches of the Cochrane Library, Scopus, PubMed, and Google Scholar databases. Eligible studies included experimental and observational designs that assessed urinary symptoms, urodynamic outcomes, or treatment response in participants aged 18 years or younger. Data extraction was performed independently by two reviewers, and risk of bias was assessed using ROBINS-I for non-randomized studies and ROB 2 for randomized controlled trials. A random-effects model was applied for the meta-analysis. Twelve studies (including four RCTs) were included. Nine studies reporting lower urinary tract symptoms showed significant reductions in daytime incontinence (RR 0.45; 95% CI 0.36–0.56; I 2 = 68%), frequency (RR 0.42; 95% CI 0.30–0.59; I 2 = 74%), urgency (RR 0.39; 95% CI 0.29–0.53; I 2 = 58%), and nocturnal enuresis (RR 0.39; 95% CI 0.21–0.73; I 2 = 60%), with an overall pooled RR of 0.43 (95% CI 0.34–0.55; I 2 = 63%). Five studies reported maximum voided volume (MVV), demonstrating significant increases in within-group analyses (MD 40.36 mL; 95% CI 17.63–63.10; I 2 = 76%) and between-group comparisons (MD 34.05 mL; 95% CI 5.53–62.76; I 2 = 77%), for an overall pooled MD of 35.95 mL (95% CI 21.88–50.03; I 2 = 84%). Other urodynamic variables (Qmax, Qave, PVR, cystometric capacity, Pdetmax, pressure–flow indices) were heterogeneously reported and synthesised narratively; where available, signals favored improved storage function. Subtype effects for MNE vs NMNE were described narratively due to limited, non-uniform reporting. Tibial nerve stimulation is associated with clinically meaningful improvement in core paediatric LUTS and a pooled increase in MVV, with a favourable safety profile. Benefits appear clearest in non-neurogenic phenotypes, while enuresis shows short-term gains with uncertain durability without maintenance. This review refines the evidence base by pairing symptom effects with urodynamic context and highlights priorities for future trials: ICCS-aligned endpoints, standardized and quantitative urodynamics, phenotype stratification (including MNE vs NMNE), and prospective evaluation of maintenance protocols. • PTNS significantly reduces incontinence, urgency, frequency, and enuresis • PTNS increases bladder capacity in children with bladder dysfunction • PTNS shows higher efficacy in non-neurogenic bladder dysfunction • PTNS is safe, minimally invasive, and well tolerated by pediatric patients