Editing Functional: Neuromodulation (section)

=== Posterior Tibial Nerve Stimulation (PTNS) ===
* '''Posterior tibial nerve is a mixed sensory and motor nerve'''
** '''Contains fibers originating from spinal roots L4 through S3 that modulate the somatic and autonomic nerves to the pelvic floor muscles, bladder, and urinary sphincter.'''
* <span style="color:#ff0000">'''Efficacy'''</span>
**<span style="color:#ff0000">'''Improves OAB symptoms with magnitude to anti-muscarinics, but PTNS has a better adverse event profile.[https://pubmed.ncbi.nlm.nih.gov/31039103/ ★]'''</span>
**Clinical trials of PTNS have been performed in detrusor overactive conditions with and without pelvic pain and urinary retention. Although clinical trials have produced variable results, PTNS is minimally invasive, demonstrates efficacy, and is easily applicable and well tolerated in all the LUT conditions studied.
**'''One of the major limitations of this therapy is the need for continued and repeated sessions'''
*<span style="color:#ff0000">'''Indications'''</span>
**'''<span style="color:#ff0000">2019 AUA OAB Guidelines[https://pubmed.ncbi.nlm.nih.gov/31039103/ ★]</span>'''
***'''<span style="color:#ff0000">May be offered as third-line treatment in a carefully selected patient population, characterized by moderately severe baseline incontinence and frequency and willingness to comply with the PTNS protocol.</span>'''
****Patients must also have the resources to make frequent office visits both during the initial treatment phase and to obtain maintenance treatments in order to achieve and maintain treatment effects.
**'''FDA-approved for OAB treatment<span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/31039103/ ★]</span>'''
*<span style="color:#ff0000">'''Adverse events (2):[https://pubmed.ncbi.nlm.nih.gov/31039103/ ★]'''</span>
**<span style="color:#ff0000">'''Painful sensation during stimulation</span>''' that did not interfere with treatment
**<span style="color:#ff0000">'''Minor bleeding at the insertion site'''</span>