Systematic Review of Percutaneous and Transcutaneous Posterior Tibial Neurostimulation for Lower Urinary Tract Symptoms & Lower Urinary Tract Dysfunction in Children

OBJECTIVE: To systematically evaluate the efficacy of posterior tibial nerve stimulation (TNS) in children with lower urinary tract symptoms (LUTS) and/or lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines. Databases including PubMed, EMBASE, CENTRAL, and Scopus were searched for relevant studies published before May 11, 2023. Studies included pediatric patients (< 18 years old) treated with percutaneous or transcutaneous posterior TNS (PTNS or TTNS, respectively) for LUTS or LUTD. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and data were synthesized qualitatively. Studies were categorized as mixed neurogenic (NLUTD) and non-neurogenic (NN LUTD), monosymptomatic nocturnal enuresis (MNE), and NN LUTD. RESULTS: Of 576 studies, 26 met the inclusion criteria. For mixed NLUTD/NN LUTD, PTNS had variable efficacy (0%-100%) for improving LUTS, and TTNS had at least some urinary symptom improvement for around 80% of patients. For MNE, most studies showed a mild improvement of 1-2 wet nights over 1-2 weeks with TNS. For NN LUTD, TNS led to improvement in LUTS in around 40%-70% of patients, although complete cure rates were variable. Adverse events were minimal, with only transient discomfort reported. The overall quality of evidence was low to moderate, and most studies had small sample sizes and lacked comparison groups. No studies directly compared PTNS and TTNS. CONCLUSIONS: Overall, posterior TNS via either a percutaneous or transcutaneous approach often provides at least a mild benefit to pediatric patients with LUTS and LUTD. However, the variability in study outcomes and low quality of evidence suggest a need for more robust studies with standardized outcomes and comparison groups to better establish the efficacy and role of TNS in children.