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Transcutaneous Tibial Nerve Stimulation Combined with Clean Intermittent Catheterization for Urinary Retention After
Yin Wang1, Xiao-Bing Ju2, Hao Wang3
1Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University,Nanjing, Jiangsu, China.
Objective:
To evaluate the efficacy and safety of combining transcutaneous tibial nerve stimulation (TTNS) with clean intermittent catheterization (CIC) for urinary retention following spinal cord injury (SCI).
Methods:
Forty patients with urinary retention after SCI were enrolled and classified by injury type. The primary analysis focused on 36 patients with UMN-type injury (injury level above T12), who were randomly assigned (1:1) to either the CIC group (four times daily for 3 months) or the Combination group (CIC plus twice-weekly TTNS for 3 months). TTNS was administered using surface electrodes (10 Hz, 200 µs pulse duration, 30 min duration, intensity 0-50 mA based on tolerance). Primary outcomes were urodynamic parameters (detrusor pressure, post-void residual volume (PVR), maximum flow rate (Qmax), urethral pressure, bladder capacity). Secondary outcomes included health-related quality of life (HRQoL) and symptom severity. Assessments were performed at baseline, 6 weeks, and 3 months. Four patients with lower motor neuron (LMN)-type injury are reported descriptively.
Results:
In the UMN primary analysis (N=36), the Combination group showed significantly greater improvements in all urodynamic parameters and HRQoL at 3 months compared to the CIC group (all P<0.001). The magnitude of improvement was substantial: detrusor pressure increased by 62.8±10.5 cmH2O, PVR decreased by 226.5±51.8 mL, and Qmax increased by 7.6±2.7 mL/s. No serious adverse events were reported. The four LMN patients showed numerical improvements but were not included in the primary inferential analysis due to insufficient sample size.
Conclusion:
TTNS combined with CIC represents an effective and safe treatment strategy for patients with UMN-type urinary retention after SCI, significantly improving urodynamic function and quality of life. The efficacy of TTNS in patients with LMN injury requires separate investigation in adequately powered studies. These findings provide preliminary evidence for this synergistic approach as a promising option for urinary management after SCI.