DESCRIPTION
Posterior tibial nerve stimulation (PTNS) is a technique of electrical neuromodulation being proposed for the treatment of voiding dysfunction in individuals who have failed behavioral and/or pharmacologic therapies. Examples of voiding dysfunction include: urinary frequency, urgency, incontinence, and nonobstructive retention. Although the posterior tibial nerve is located near the ankle, it is derived from the lumbar-sacral nerves (L4-S3), which control the bladder detrusor and perineal floor. Altering the function of the posterior tibial nerve with PTNS is being studied as a way to improve voiding function and control.
PTNS can be administered as an invasive or noninvasive procedure. The invasive procedure for PTNS consists of the insertion of a needle above the medial malleolus into the posterior tibial nerve. This is followed by the application of low voltage (10mA, 1-10 Hz frequency) electrical stimulation that produces sensory and motor responses (i.e., a tickling sensation and plantar flexion or fanning of all toes). The noninvasive procedure for PTNS is delivered with surface electrodes. It has been reported that PTNS is administered during 30-minute sessions given 1-3 times a week for 10-12 weeks. However, an optimal treatment approach and the durability of PTNS are unknown.
POLICY
Posterior tibial nerve stimulation for treatment of urinary dysfunction, including, but not limited to, the following: urinary frequency, urgency, incontinence and retention is considered investigational.
ADDITIONAL INFORMATION
Randomized trials with appropriate control groups are needed to determine the durability, short-term and long-term effects of PTNS on voiding dysfunction.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2008). Posterior tibial nerve stimulation for voiding dysfunction (7.01.106). Retrieved May 19, 2009 from BlueWeb. (5 articles and/or guidelines reviewed)
Finazzi Agro, E., Campagna, A., Sciobica, F., Petta, F., Germani, S., Zuccala, A., et al. (2005). Posterior tibial nerve stimulation: Is the once-a-week protocol the best option? The Italian Journal of Urology and Nephrology, 57 (2), 119-123. Abstract retrieved April 26, 2007 from PubMed database.
Hayes. Medical Technology Directory. (2008, September). Electrical percutaneous tibial nerve stimulation for urinary voiding dysfunction. Retrieved May 19, 2009 from www.Hayesinc.com/subscribers. (50 articles and/or guidelines reviewed)
Kabay, S. C., Yucel, M., & Kabay, S. (2008). Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: Urodynamic study. Urology, 71 (4), 641-645. (Level 4 Evidence - Independent study)
Kim, S. W., Paick, J. S., & Ku, J. H. (207). Percutaneous posterior tibial nerve stimulation in patients with chronic pelvic pain: a preliminary study. Urologia Internationalis, 78 (1), 58-62. Abstract retrieved May 19, 2009 from PubMed database.
Nuhoglu, B., Fidan, V., Ayyildiz, A., Ersoy, E., & Germiyanoglu, C. (2006). Stoller afferent nerve stimulation in woman with therapy resistant over active bladder: A 1-year follow up. International Urogynecology Journal and Pelvic Floor Dysfunction, 17 (3), 204-207. Abstract retrieved April 26, 2007 from PubMed database.
U. S. Food & Drug Administration. (2007, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071822. Retrieved May 19, 2009 from http://www.fda.gov/cdrh/pdf7/K071822.pdf.
van der Pal, F., van Balken, M. R., Heesakkers, J. P., Debruyne, F. M., & Bemelmans, B. L. (2006). Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: Is maintenance treatment necessary? BJU International, 97 (3), 547-550. Abstract retrieved April 26, 2007 from PubMed database.
van der Pal, F., van Balken, M. R., Heesakkers, J. P., Debruyne, F. M., Kiemeney, L. A., & Bemelmans, B. L. (2006). Correlation between quality of life and voiding variables in patients treated with percutaneous tibial nerve stimulation. BJU International, 97 (1), 113-116. Abstract retrieved April 26, 2007 from PubMed database.
Zhan, J., Bai, J., Zhou, Y.,Oi, G., & Du, L. (2008). Posterior tibial nerve stimulation twice a week in patients with interstitial cystitis. Urology, 71 (6), 1080-1084. (Level 2 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 9/9/2007
MOST RECENT REVIEW DATE: 6/11/2009
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