Case Report: Low-frequency tibial nerve stimulation: demonstrating a novel therapeutic option for Fowler’s syndrome through a pilot case series

Fowler’s Syndrome is a critically under-researched area of Women’s Urological health. The condition, which causes severe urinary retention in the absence of any obvious obstructive pathology, lacks any non-invasive options for treatment. Transcutaneous Tibial Nerve Stimulation (TTNS) is an established treatment strategy for disorders of incontinence that is non-invasive, safe, and efficacious. Computer based modelling and preliminary animal experimentation indicates that ultra-low frequency TTNS (1–2 Hz) may induce an excitatory effect on bladder function that is of particular therapeutic relevance to Fowler’s Syndrome. Therefore, the present case series describes a three-armed randomised-control (crossover) pilot study conducted from a biomechanical perspective in a population suffering from Fowler’s Syndrome. The study aimed to address the question of if the novel application of low-frequency TTNS could ameliorate the symptoms of Fowler’s Syndrome. Patients ( N = 6) were administered either ultra-low frequency TTNS (1 Hz) or placebo. The objective outcome measure of the study was the change in voiding efficiency in response to intervention. 50% ( N = 3) participants displayed a positive response to treatment, with a median increase in Voiding Efficiency of 6.3 to 12.6% across test conditions. Two participants displayed a negative response to the intervention, (median −3.6 to −20.9%) which may have been due to placebo effects but should be considered in future. The study indicated that TTNS may be capable of ameliorating the symptoms of Fowler’s Syndrome, to a significant degree in one case. The work provides a foundation for future clinical research. The authors hope that should the results be confirmed by further clinical study they will have considerable impact on patient care.