Percutaneous Tibial Nerve Stimulation for Neurogenic Bladder Due to Severe Lumbosacral Disc Herniation

Abstract

Background: Neurogenic bladder (NB), resulting from neurological disorders, significantly affects quality of life and increases healthcare costs. Although percutaneous tibial nerve stimulation (PTNS) is an established therapy for central nervous system-related lower urinary tract dysfunction (LUTD), its efficacy in treating intervertebral discogenic LUTD remains unexplored. This study presents the first documented case of PTNS applied to NB secondary to severe lumbosacral herniated intervertebral disc (HIVD). Methods: A 39-year-old female, hospitalized twice for worsening HIVD, presented with LUTD, including urgency, weak stream, and nocturia. Magnetic resonance imaging confirmed progressive L5-S1 disc extrusion with sacral nerve compression. PTNS, delivered via electronic stimulation through acupuncture needles at SP6 and KI3, was administered daily for 10 days during hospitalization. Symptom scores relating to LUTD, pain, and physical disability were evaluated. Result: The American Urological Association symptom score showed significant improvement (from 20 to 6 and 22 to 15 at 12 weeks after the first and second hospitalizations, respectively). Recovery of voiding function was slower during the second hospitalization, possibly due to increased sacral nerve compression and chronic pathologic condition. Pain and functional disability, assessed using the NRS and ODI, improved by approximately 50% (from 55 to 25 and 80 to 45 during the first and second hospitalizations, respectively) and two-thirds (from 66 to 42 and 93 to 66, respectively). Conclusions: This case suggests that PTNS may be a viable conservative therapy for HIVD-associated LUTD. Further research is required to elucidate its mechanistic effects and clinical efficacy in peripheral nerve-related bladder dysfunction.

Keywords: PTNS; case report; herniated disc; neurogenic bladder.

Figure 1

Timeline of the patient’s treatment history with radiological findings. (A) Timeline of medical events from pain onset to two hospital admissions, including hospitalization periods, follow-ups, and treatment contents. (B) Lumbar spine magnetic resonance imaging (MRI). MRI scans were performed twice on the admission days ((a–c): first Adm; (d–f): second Adm). (a,d) show sagittal T2-weighted images, while (b,e) and (c,f) present axial views at the mid-L5 and mid-S1 levels, respectively. Adm—admission; D/C—discharge; F/U—follow-up; PTNS—percutaneous tibial nerve stimulation; Tx.—treatment.

Figure 2

Course of symptoms. (A) The prognostic course of lower urinary tract dysfunction (LUTD) severity is assessed using the American Urological Association urinary symptom score, which evaluates symptoms exhibited over the past month. However, at the 10-day assessment, the score reflected symptom changes over the initial 10 days of treatment. (B) Changes in scores on the numeric rating scale for low back pain and leg pain, as well as the Oswestry Disability Index for physical function, are evaluated. AUA—American Urological Association; LBP—low back pain; NRS—numeric rating scale; ODI—Oswestry Disability Index.