Transcutaneous Electrical Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

Context: Transcutaneous electrical nerve stimulation (TENS) is a promising therapy for non-neurogenic lower urinary tract dysfunction and might also be a valuable option in patients with an underlying neurological disorder. Objective: We systematically reviewed all available evidence on the efficacy and safety of TENS for treating neurogenic lower urinary tract dysfunction. Evidence acquisition: The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Evidence synthesis: After screening 1943 articles, 22 studies (two randomised controlled trials, 14 prospective cohort studies, five retrospective case series, and one case report) enrolling 450 patients were included. Eleven studies reported on acute TENS and 11 on chronic TENS. In acute TENS and chronic TENS, the mean increase of maximum cystometric capacity ranged from 69 ml to 163 ml and from 4 ml to 156 ml, the mean change of bladder volume at first detrusor overactivity from a decrease of 13 ml to an increase of 175 ml and from an increase of 10 ml to 120 ml, a mean decrease of maximum detrusor pressure at first detrusor overactivity from 18 cmH20 to 72 cmH20 and 8 cmH20, and a mean decrease of maximum storage detrusor pressure from 20 cmH20 to 58 cmH20 and from 3 cmH20 to 8 cmH20, respectively. In chronic TENS, a mean decrease in the number of voids and leakages per 24 h ranged from 1 to 3 and from 0 to 4, a mean increase of maximum flow rate from 2 ml/s to 7 ml/s, and a mean change of postvoid residual from an increase of 26 ml to a decrease of 85 ml. No TENS-related serious adverse events have been reported. Risk of bias and confounding was high in most studies. Conclusions: Although preliminary data suggest TENS might be effective and safe for treating neurogenic lower urinary tract dysfunction, the evidence base is poor and more reliable data from well-designed randomised controlled trials are needed to make definitive conclusions. Patient summary: Early data suggest that transcutaneous electrical nerve stimulation might be effective and safe for treating neurogenic lower urinary tract dysfunction, but more reliable evidence is required. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.