Introduction: As of 2011, an estimated 29.8 million adults in the United States are living with overactive bladder (OAB). Peripheral Tibial Nerve Stimulation (PTNS) is a tertiary treatment for patients refractory to behavioral and pharmacological interventions. This article reviews the history of the use of PTNS in Urology from its roots in acupuncture to the third-line therapy we routinely offer patients.
Methods: We reviewed medical literature, text, magazines, and multimedia surrounding the history and development of PTNS.
Results: The first undisputed record of an organized system of diagnosis and treatment using acupuncture is The Yellow Emperor’s Classic of Internal Medicine, which contains techniques dating to 2600 BCE. This writing first described the existence of “meridians'' through which energy (Qi) flows. In 1683, Dr. Willem ten Rhyne introduced this technique to Western Europe when he published Dissertation of Arthritis, Logarithmic Text, Acupuncture and Three Subjects after witnessing it in Japan. In 1983, Edward J. McGuire and colleagues published the first paper to describe PTNS treatment for OAB in human patients. They directly cited acupuncture as their inspiration for the technique. In 1999, Marshall L. Stoller refined the technique and expanded treatment regimens to the 10-12 week protocol that is still in use today. In 2010 Kenneth M. Peters and colleagues as well as Enrico Finazzi-Agro and colleagues published sham-controlled studies with similar results after weekly treatments for 12 weeks. The success of these studies directly led to the FDA clearing PTNS for treatment of overactive bladder even though its specific mechanism remained poorly understood. Several exciting new developments like implantable versions are now making PTNS more convenient and potentially more efficacious. Notably, there is a physiological basis for why PTNS may treat chronic pelvic pain, but efficacy for this condition remains contentious.
Conclusions: Since Edward J. McGuire and colleagues established the method in 1983, PTNS has proven to be an effective, minimally invasive treatment for OAB. Current advances in delivery systems are making this procedure more accessible and appealing than ever. All the while it is nearly as puzzling as the ancient technique from which it is derived.
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