Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9139
Revised: October 26, 2013
Accepted: November 2, 2013
Published online: December 28, 2013
Processing time: 147 Days and 3.7 Hours
Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures. Sacral nerve stimulation (SNS) is the main form of neurostimulation that is in use today. Posterior tibial nerve stimulation (PTNS) - both the percutaneous and the transcutaneous routes - remains a relatively new entry in neurostimulation. Though in its infancy, PTNS holds promise to be an effective, patient friendly, safe and cheap treatment. However, presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence. This seems to have arisen as the strong, uniform and evidence based data on SNS remains to have been unchallenged yet by the weak, disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS. The use of PTNS is slowly gaining acceptance. However, several questions remain unanswered in the delivery of PTNS. These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS. This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence.
Core tip: Posterior tibial nerve stimulation though in its infancy, holds promise to be an effective, patient friendly and cheap treatment for faecal incontinence refractory to available conservative options. However, several questions remain unanswered and pose dilemmas regarding the delivery of this treatment. Solving these dilemmas could hold the key for unlocking the pathway for this treatment to be brought into the limelight.