Transcutaneous Tibial Nerve Stimulation (TTNS) for Treating Neurogenic Lower Urinary Tract Dysfunction: A Multicentre, Randomised, Sham-controlled, Double-blind Clinical Trial (bTUNED)

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    University of Zurich
Updated on 27 October 2022


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 (DO) 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 randomised 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, this study will be the first adequately sampled and powered, randomised, sham-controlled, double-blind trial assessing transcutaneous TNS (TTNS) for NLUTD. It 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 clinical 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.

Condition Neurogenic Bladder Dysfunction
Treatment SHAM TTNS, Experimental TTNS
Clinical Study IdentifierNCT04315142
SponsorUniversity of Zurich
Last Modified on27 October 2022


Yes No Not Sure

Inclusion Criteria

Informed consent
Age >18 years
Last urethro-cystoscopy and bladder washing cytology within 1 year before inclusion
Last urodynamic investigation within 6 months and no change of bladder medication since then
Refractory LUTD due to a neurological disorder
Neurogenic OAB (i.e. urgency frequency syndrome with or without urgency incontinence) refractory to antimuscarinics (pharmacotherapy for at least 4 weeks with at least 2 antimuscarinics)
Neurogenic voiding dysfunction (i.e. incomplete bladder emptying/incomplete / complete urinary retention) refractory to alpha-blocker (pharmacotherapy with an alpha-blocker for at least 4 weeks)
Combination of neurogenic OAB and neurogenic voiding dysfunction (i.e. urgency frequency syndrome with or without urgency incontinence and incomplete / complete 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)
Motor response induced by TTNS stimulation at least at one leg
Willing not to change or start any new medications or treatments for the LUT during the entire study period (from screening till unblinding)

Exclusion Criteria

Contraindications to the investigational product
Known or suspected non-adherence, drug or alcohol abuse
Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia
Participation in another study with investigational drug or product within the 30 days preceding and during the present study
Neuromodulation treatment for urological indication in the last six months or ongoing
Botulinum toxin injections in the detrusor and/or urethral sphincter in the last six months
Women who are pregnant or breast feeding
Intention to become pregnant during the course of the study
Individuals especially in need of protection (according to Research with Human Subjects published by the Swiss Academy of Medical Sciences [[]](\])
Enrolment of the investigator, his/her family members, employees and other dependent persons
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