Transcutaneous posterior tibial nerve stimulation for treatment of detrusor hyperreflexia in spinal cord injury

Posterior tibial nerve (PTN) electrical stimulation was described 20 years ago as a minimally invasive treatment for urge incontinence due to detrusor hyperreflexia (DH) in spinal cord injury (SCI).(1) Interestingly, this site is dose to the Sanyinjiao (Sp 6) point used in Chinese acupuncture for urinary continence problems. More recently, PTN stimulation using percutaneous electrodes has been successfully used to treat urge incontinence in nonneuropathic cases.(2) Pudendal nerve afferents (S2 to S4) are well known to suppress DH but it is not intuitively obvious that PIN afferents should have a similar effect.(3) However, the PTN is derived from L4 and L5, and S1 to S3 nerve roots and, therefore, shares common roots with those subserving bladder function (S2 to S4). We were intrigued that none of the different techniques of PTN stimulation described previously have been explored for use in the management of urinary incontinence in SCI. In this preliminary report we detail our successful application in an individual with SCI with intractable urinary symptoms.