The knowledge that the afferent nerves from the posterior tibial nerve communicate to the sacral center of micturition facilitated the invention of the ?PTNS? method (Percutaneous Tibial Nerve Stimulation) for the management of lower urinary tract dysfunction. The electroacupuncture technique used consists of the administration of short electric stimuli via percutaneously placed needles. When one places these needles 5cm above the lateral malleolus of the tibia, the posterior tibial nerve can be stimulated via an external generator.

B. C. Ruiz, X. M. Pena Outeirino, et al from Sevilla, Spain report the results of a prospective study of 51 female patients with lower urinary tract symptoms treated with PTNS in the January, 2004 issue of European Urology. Of the 51 patients, 26 complained of urgency/frequency, 22 of urge incontinence and 3 carried a diagnosis of interstitial cystitis. Patients received weekly stimulations of 30 minutes over a 10-week period. Additionally, patients completed quality of life questionnaires and detailed voiding diaries before, during, and after the study.

The variables analyzed included daytime and nighttime frequency, voided volume, leakage episodes and hypogastric pain. Mean follow-up was 21 months. All patients had failed more conservative treatments with anti-cholinergic medications.

A statistically significant improvement was seen in all variables among all women. Particularly marked was the improvement in urinary frequency and voided volume. Twenty-four hour frequency went from 12.1 to 8.1 post-treatment. Voided volume improved from 138 to 220cc. The reduction in incontinence episodes, although showing a statistically significant decrease from 2.1 to 0.8, may not be as clinically significant. Hypogastric pain was also decreased in one-third of patients. Improvement in quality of life indices were also significant with 82% feeling ?bad? and 0% feeling ?happy? prior to treatment, while 45% felt ?happy? and only 18% ?bad? after treatment.

In conclusion, peripheral afferent nerve stimulation improved all variables of lower urinary tract symptoms in women over 55 years old. These results, together with the scarce morbidity of this method, may make it an effective alternative in the treatment of lower urinary tract symptoms refractory to medications. The authors caution that long-term randomized studies must follow in order to confirm these early impressions.

Eur Urol 2004;44:65-69.