Transcutaneous Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction
Transcutaneous Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction
Many patients with neurological diseases suffer from neurogenic lower urinary tract
 dysfunction (NLUTD), which often severely impairs quality of life, due to urinary urgency
 with or without incontinence and voiding dysfunction. In addition, the upper urinary tract
 may be jeopardized because of high intravesical pressure caused by detrusor overactivity with
 concurrent detrusor-sphincter-dyssynergia and/or low bladder compliance. The treatment of
 NLUTD is a challenge since conventional conservative therapies often fail and more invasive
 treatments such as intradetrusor onabotulinumtoxinA injections, bladder augmentation and
 urinary diversion have to be considered. Neuromodulation therapies including tibial nerve
 stimulation (TNS) may be alternative non-invasive treatment options. Indeed, TNS is an
 effective and safe treatment for idiopathic overactive bladder proven in randomized
 controlled trials (RCTs), but its value in neurological patients is unclear. In a recent
 systematic review, the investigators found evidence that TNS might become a promising
 treatment option for NLUTD, however, more reliable data from well-designed RCTs are urgently
 needed to reach definitive conclusions. However, the investigators study will be the first
 adequately sampled and powered, randomized, placebo-controlled, double-blind trial assessing
 transcutaneous TNS (TTNS) for NLUTD. This trial will provide significant insights into the
 efficacy of TTNS in patients suffering from NLUTD and in the case that this treatment is
 really effective in the neurological population, the investigators findings would completely
 revolutionize the management of NLUTD in daily clinical practice. Moreover, this
 interdisciplinary trial will relevantly influence the neurological and urological approach in
 the management of NLUTD promoting future collaborative projects improving patients' medical
 care and underlying the pioneering role of Switzerland in the rapidly developing and
 ambitious research field of neuro-urology.
Inclusion Criteria:

 -  Refractory LUTD due to a neurological disorder:

 -  Urgency frequency syndrome and/or urgency incontinence refractory to antimuscarinics
 (pharmacotherapy for at least 4 weeks with at least 2 antimuscarinics)

 -  Chronic urinary retention refractory to alpha-blocker (pharmacotherapy with an
 alpha-blocker for at least 4 weeks)

 -  Combination of urgency frequency syndrome and/or urgency incontinence and chronic
 urinary retention refractory to antimuscarinics (pharmacotherapy for at least 4 weeks
 with at least 2 antimuscarinics) and alpha-blocker (pharmacotherapy with an
 alpha-blocker for at least 4 weeks)

 -  Age >18 years

 -  Informed consent

 Exclusion Criteria:

 -  Botulinum A toxin injections in the detrusor and/or urethral sphincter in the last 6
 months

 -  Age <18 years

 -  Pregnancy

 -  Individuals especially in need of protection (according to Research with Human
 Subjects published by the Swiss Academy of Medical Sciences
 www.samw.ch/en/News/News.html)

 -  No informed consent