E-Posters-10265

10265_Stone

Pdf Summary

Percutaneous tibial nerve stimulation (PTNS) is an effective treatment for overactive bladder, but it lacks a good long-term solution and poses inconvenience for patients. This study explored the course of the tibial nerve and its relationship to surrounding anatomy in order to develop a surgical technique and identify optimal placement for an implantable neurostimulator as an alternative treatment option. <br /><br />Four preserved lower extremity specimens were used for surgical exploration. The tibial nerve was identified from the popliteal fossa to the ankle, noting its relationship to palpable bony and ligamentous landmarks. The nerve was found to run deep to the soleus muscle and become superficial at the confluence of the medial border of the soleus and the flexor digitorum longus. It then traveled parallel to the calcaneal tendon towards the foot and underneath the flexor retinaculum. The length of this superficial path varied between 5-8cm. The nerve traveled in a bundle with the posterior tibial artery and vein.<br /><br />Based on these findings, a proposed procedure for implanting a quarter-sized neurostimulator device was developed. The device would be centered 3cm cephalad and 3cm posterior to the medial malleolus, which was found to be an ideal anatomical landmark for locating the tibial nerve. By creating a horizontal incision cephalad to this point and dissecting through the subcutaneous tissue, the device could be inserted without disrupting neurovascular structures.<br /><br />This study successfully identified the important landmarks surrounding the tibial nerve and developed a surgical technique for implanting an electrical stimulation device in a reliable fashion. The results provide valuable insights for the development of an implantable neurostimulator as an alternative treatment for overactive bladder.

Keywords

Percutaneous tibial nerve stimulation

overactive bladder

implantable neurostimulator

surgical technique

optimal placement

lower extremity specimens

medial malleolus

electrical stimulation device

alternative treatment

neurovascular structures