| Objective To systematically evaluate the efficacy of percutaneous tibial nerve stimulation(PTNS)in the treatment of central neurogenic bladder by using the method of evidence-based medicine and on the basis of existing randomized controlled trials,and comprehensively analyze the possible mechanism of PTNS.In order to provide evidence for clinical application and promotion of PTNS in the treatment of central neurogenic bladder.Methods We searched Pub Med,EMBASE,Web of science,Cochrane library,Clinicaltrials,Chinese Biomedical Literature Database(CBM),Wanfang Database,VIP Database and China knowledge Network(CNKI)about the clinical randomized controlled trials of percutaneous tibial nerve stimulation in the treatment of central neurogenic bladder.The search terms were set to related Chinese and English medical subject words and free words of "tibial nerve" and "neurogenic bladder" and "overactive bladder" and "lower urinary tract dysfunction" and "randomized controlled trial".The retrieval time is from the date of the establishment of the database to August 2019.Literature was screened independently by two researchers strictly followed the inclusion and exclusion criteria,and carry out supplementary retrieval according to the relevant references in the included literature.The data extraction in the included literature was carried out independently by two researchers,and the data included the basic data of the subjects,the experimental methodology,the measures of the experimental group and the control group,and the results of the experiment.The literature was assessed using the risk of bias assessment tool recommended by the Cochrane manual(5.0.1),and the quality assessment was performed using the quality assessment scale provided by the physical therapy evidence database(PEDro).Outcome data were Meta analyzed using Rev Man 5.3 software.The main outcome indicators of this study were bladder capacity and maximum detrusor pressure,and the secondary outcome indicators were residual urine and bladder diary.Results A total of 8 randomized controlled trials were included(3 cases of spinal cord injury,3 cases of multiple sclerosis,1 case after stroke,1 case of Parkinson’s disease,a total of 233 patients).The PEDro scores of included study ranged from 6 to 10.The results of Meta-analysis showed that compared with the control group,PTNS was effective in the treatment of bladder capacity(SMD=0.67,95% CI:0.29~1.05,P=0.0005),residual urine(MD=-39.89,95%CI:-40.73~-39.05,P< 0.00001),frequent micturition symptoms(OR=2.93,95%CI:1.09~7.84,P=0.03),rgency(OR=2.93,95%CI:1.09~7.84,P=0.03)and urinary incontinence(OR=3.25,95%CI:1.08~9.76,P=0.04).There was no significant difference in maximum detrusor pressure between the control group and the control group(MD=2.83,95% CI:-0.28~5.94,P=0.07).Conclusion As a non-invasive peripheral nerve stimulation therapy,PTNS may improve bladder function by influencing nerve regulation of sacral spinal micturition central,saphenous nerve co-activation,autonomic nerve regulation,and recombination of cortical network plasticity.The results of the meta-analysis showed that,compared with the control group,there was evidence that PTNS had better efficacy in improving bladder volume,residual urine,urinary frequency,urgency and urinary incontinence,but there was no evidence that PTNS was more effective at reducing maximum detrusor pressure than the control group.On the basis of RCTs included in this study,PTNS is safe,easy to operate and to be accepted by patients,and suitable for community and family rehabilitation treatment,which is worthy of promotion.Therefore,PTNS is recommended as a routine clinical rehabilitation treatment for neurogenic bladder.In order to systematically and comprehensively understand the therapeutic mechanism,efficacy and safety of PTNS,more high-quality randomized controlled trials are needed in the future. |
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