Open Access

ARTICLE

Posterior tibial nerve stimulation: is ultrasound guided needle placement more accurate?

Steven J. Lomax¹, Daniela A. Haehn¹, Eric Robinson¹, Rachel Pung Page², Edsel Bittencourt³, Mark F.B. Hurdle³, Steven P. Petrou¹

1 Department of Urology, Mayo Clinic, Jacksonville, Florida, USA
2 Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
3 Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida, USA
Address correspondence to Dr. Steven P. Petrou, Department of Urology, Mayo Clinic FL, 4500 San Pablo Road South, Jacksonville, FL 32224 USA

Canadian Journal of Urology 2021, 28(4), 10778-10782.

Abstract

Introduction: To compare the accuracy of the transcutaneous ultrasound (US) in detecting the tibial nerve (TN) as opposed to digital palpation in the performance of posterior tibial nerve stimulation (PTNS).
Materials and methods: After Institutional Review Board (IRB) approval, 25 adults were enrolled to quantify the difference in position of the distal TN by the use of US as opposed to cutaneous palpation. The position of the TN was determined first by the palpation method and then by using a L12-4MHz high frequency Linear Array Transducer. The difference in position between the two methods was determined in both proximal-distal (PD [Knee-Sole]) and anterior-posterior planes (AP). Statistical analysis was completed with numeric variables summarized with the sample median, range, and interquartile range (IQR). Categorical variables were summarized with the number and percentage of patients. Comparisons between AP and PD distances were performed using a nonparametric Wilcoxon signed rank test. Box and whisker plots were used to display individual observations graphically. All analyses and graphics were performed using SAS statistical software (version 9.4M5, SAS Institute Inc., Cary, NC, USA).
Results: Twenty-five patients were studied. The median AP distance between US and digital palpation was 2 mm (range, 0-5 mm; IQR, 2-3 mm). The median PD distance between US and digital palpation was 4 mm (range, 0-9 mm; IQR, 3-5 mm). The median difference between the AP and PD distances was 2 mm (range, -3-7 mm; IQR, 0-4 mm, p < 0.001).
Conclusion: The use of US identifies the nerve with statistically significant greater accuracy than palpation technique along the PD plane.

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