SUFU 2019: Assessment of Transcutaneous Ultrasound in Identification of the Posterior Tibial Nerve

Miami, FL ( Percutaneous tibial nerve stimulation (PTNS) is a recognized treatment option for patients with urinary dysfunction. The conventional method of locating a tibial nerve includes physical palpation of the ankle. However, incorrect identification may decrease the effectiveness of PTNS therapy.

Researchers from the Mayo Clinic conducted a study to evaluate efficacy of transcutaneous ultrasound in assessment of tibial nerve location. Study sample included a total of 25 participants (7 male and 18 female) with a median age of 37 years (range, 19 -70; IQR, 31 –51). The ssubject's tibial nerve was first identified by the physical palpitation, and then by using the Phillips Lumify Mobile App Based ultrasound. Difference in distance was recorded in proximal-distal (PD) and anterior-posterior (AP) planes (Figure 1).

Figure 1
SUFU WM 2019 PD vs AP planes

Dr. Lomax and his colleagues found a median 2 mm difference between the ultrasound measurement and cutaneous palpitation in AP plane (range, 0 –5 mm; IQR, 2  -3 mm). Higher median difference of 4 mm was identified in PD plane (range, 0 –9 mm; IQR, 3 –5 mm). The median difference between PD and AP was 2 mm (range, -3 –7 mm; IQR, 0 –4 mm) (Figure 2).

Figure 2
SUFU WM 2019 figure 2 graph

The study suggests that transcutaneous ultrasound is a more accurate tool of tibial nerve location compared to conventional identification. Future research is needed to assess if this finding will affect long-term effectiveness of PTNS therapy.

Presented by: Steven Lomax, MD, Department of Urology, Mayo Clinic Florida, Jacksonville, Florida 

Written by: Hanna Stambakio, BS, Clinical Research Coordinator, Division of Urology, University of Pennsylvania, Twitter: @AStambakio at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida