Percutaneous Tibial Nerve Stimulation (PTNS) is a modulation technique approved for the treatment of overactive bladder (OAB) but also proposed for non-obstructive urinary retention (NOUR), neurogenic bladder, pediatric voiding dysfunctions and chronic pelvic pain/painful bladder syndrome (CPP/PBS). The available literature show data obtained mainly in female patients, whilst data on male patients are lacking so that guidelines on lower urinary tract symptoms (LUTS) in male patients may not consider this treatment. The aim of this paper was investigating the efficacy of PTNS treatment on male patients affected by different lower tract dysfunctions, including overactive bladder (OAB), underactive bladder (UAB) and neurogenic dysfunctions of the lower urinary tract (LUT).

We included in this study all male patients, affected by lower urinary tract dysfunction and neurogenic disease, treated by means of PTNS at our center in a period ranging from 2020 to 2021. Exclusion criteria were comorbidities (Diabetes Mellitus, active urinary infections, bladder or kidney stones, sexual trasmitted diseases, bladder and prostate malignancy), missing data or patients who dropped out during the treatment. All patients had been investigate by non-invasive (uroflowmetry) and invasive urodynamics cystometry and pressure/flow study), questionnaires (IPSS, OAB-q SF, IIEF5, PEDT). PTNS treatment was composed of 30-min sessions once a week for 12 consecutive weeks and was performed using a 34-Gauge needle electrode inserted 4–5 cm cephalad to the medial malleolus. A Urgent® PC neuromodulator (Uroplasty, Minnetonka, MN, USA) was employed to deliver continuous square waveform electric current in 200μs pulses at a frequency of 20 Hz. Response to the treatment was defined a response 1 (very much better) or 2 (much better) at the Patient Global Impression of Improvement (PGI-I) tool, an instrument by which patients can evaluate their perception of improvement in a scale of seven grades, ranging from 1 (very much better) to 7 (very much worse).

A total of 30 male patients were analyzed, but 11 were excluded for missing data or because dropped out during follow–up. Nineteen were thus included in this study. Twelve patients had neurogenic diseases (MS, stroke or spinal injury), 7 had idiopathic LUTS. Mean age was 55 years (25–73 years). Five patients performed clean intermittent catheterization (CIC) (mean 5 CIC/day). Four patients (21,03%) presented only bladder filling LUTS, 5 bladder voiding LUTS (26,31%) and 10 bladder filling and voiding LUTS (56,63%). At the end of treatment 11 patients (57,9%) considered their conditions “very much better” or “much better” and were considered responders; 5 patients (26,31%) considered their conditions “better”; whilst 3 patients (15,78%) did not note any change. None patient
has reported a worsening of LUTS. After treatment, mean Qmax index improves from 11,5 mL/sec to 15,2 mL/sec and mean post voiding residual (PVR) decreases to 60 mL on average. Three out of five patients (60%) who had used intermittent catheterization, reduced the numbers of CIC/die.

Several studies reported the efficacy of transcutaneous electrical stimulation and PTNS in treating OAB, mainly in female patients. The available literature on PTNS treatment in male population with LUTS (especially underactive bladder) is limited and this technique has been studied mainly for the treatment of non-bacterial prostatitis or chronic pelvic pain. In our center, we propose PTNS to a mixed population of patient with LUTS refractory to medical drugs, comprising patients with UAB and neurogenic LUT dysfuntion, thus expanding the use of this minimally invasive, complication-free technique. This study shows that also male patients with different conditions can benefit from PTNS. In our series, around 60% of patients were considered successfully treated, according to the used definition. This percentage of success is comparable to that observed in other series comprising a mixed or prevalently female population. Strengths of this study are: homogeneous data coming from one center, with an invasive urodynamic
evaluation carried out in each patient and an accurate pre- and post-treatment evaluation comprising questionnaires and non-invasive urodynamic tests. Weaknesses of this study are the retrospective design, the different clinical conditions and the little number of the patients included.

This paper suggests that PTNS is a feasible and minimally invasive technique effective also in male patients with LUTS, with a success rate (around 60%) comparable with the available literature for female or mixed population. Data coming from this study can be used to design prospective, randomized and larger studies needed to confirm these findings.