Influence of Transcutaneous Tibial Nerve Stimulation on Postoperative Catheter-Related Bladder Discomfort in Urology: A Prospective, Randomized, Controlled Trial

Influence of Transcutaneous Tibial Nerve Stimulation on Postoperative Catheter-Related Bladder Discomfort in Urology: A Prospective, Randomized, Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Influence of Transcutaneous Tibial Nerve Stimulation on Postoperative Catheter-Related Bladder Discomfort in Urology: A Prospective, Randomized, Controlled Trial Xiangying Zheng, Yuwen Liu, Tao Wei, Chao Deng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6259020/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Male patients who undergo general anesthesia for urologic surgery are more prone to developing catheter-related bladder discomfort (CRBD). Transcutaneous tibial nerve stimulation (TTNS) is an established intervention for lower urinary tract dysfunction. This study aimed to evaluate the impact of TTNS on the occurrence of moderate to severe CRBD in male patients undergoing urological general anesthesia. Methods: The present study included 124 male urologic surgery patients from December 2023--June 2024 and were randomly divided into a test group and a control group via stratified block group randomization. The test group received 30 minutes of TTNS stimulation (200-μs pulses, 20/100 Hz alternating sparse-dense waves) in the recovery room after surgery, and the control group received 30 minutes of sham stimulation. The degree of CRBD and VAS scores at 0 h, 1 h, 2 h, and 6 h after tracheal extubation, the QoR-15 scores at 24 h postoperatively, the length of hospitalization, the medication remedy rates, and the occurrence of adverse reactions were compared between the two groups. Results: Compared with the control group, the present study demonstrated a statistically significant reduction in the incidence of moderate-to-severe CRBD at 0 hours after tracheal extubation in the TTNS group [ P = 0.002, CI=0.190–0.741, RR = 0.375]. The incidence of moderate to severe CRBD in the TTNS group was significantly lower than that in the C group at 1 and 2 hours after extubation ( P < 0.001, P = 0.002). Furthermore, the severity of CRBD at 0, 1, 2, and 6 hours after extubation was significantly different from that in the TTNS group ( P = 0.017, P < 0.001, P < 0.001, and P < 0.001, respectively). The VAS scores of patients in the TTNS group were notably lower than those in the C group at 0, 1, and 2 hours after tracheal extubation ( P = 0.009, P = 0.012, P = 0.013, P = 0.051, respectively). Compared with those in the C group, the QoR-15 scores at 24 hours postsurgery in the TTNS group were markedly greater ( P < 0.001). The incidence of postoperative nausea and medication rescue was lower in the TTNS group than in the C group ( P = 0.006, P < 0.001). The TTNS intervention was not associated with any adverse effects. Conclusion: TTNS effectively reduces moderate-to-severe CRBD incidence, enhances early postoperative analgesia, and improves recovery quality in male urologic surgery patients without significant safety concerns. Trial registration: This study was retrospectively registered and reviewed by a principal investigator (Xiangying Zheng) in the Chinese Clinical Trials Registry (registration number: ChiCTR2300078536) on 12/12/2023. Health sciences/Medical research/Study design/Randomized controlled trials Health sciences/Urology/Urogenital diseases/Bladder disease catheter-related bladder discomfort transcutaneous tibial nerve stimulation urology general anesthesia male Figures Figure 1 Figure 2 Figure 3 Figure 4 Summary of key points Question: Does transcutaneous tibial nerve stimulation (TTNS) reduce the incidence of postoperative catheter-related bladder discomfort (CRBD) in male patients who are receiving general anesthesia for urologic surgery? Findings: In male patients undergoing general anesthesia for urologic surgery, the postoperative administration of TTNS for 30 min reduced the incidence of moderate-to-severe CRBD, enhanced postoperative analgesia, and improved the quality of patients' postoperative recovery without evidence of significant adverse effects. Meaning: TTNS may be an effective way to reduce the incidence of postoperative moderate to severe CRBD in male patients who are receiving general anesthesia for urologic surgery. 1. Introduction Catheter-related bladder discomfort (CRBD) is a common adverse reaction following surgical procedures. However, the use of an indwelling catheter is often necessary for many surgical patients during or after the procedure 1 . CRBD occurs in 47–90% of patients after general anesthesia, and 44%-67% of patients will develop to moderate-to-severe CRBD 2 – 4 . CRBD tends to trigger emergence agitation, which can result in pain and anxiety, an increased risk of postoperative complications, and prolonged hospitalization 5 , 6 . Currently, no ideal clinical solution for CRBD exists, and medications are ineffective in preventing and treating CRBD, resulting in a high incidence of side effects such as dry mouth, nausea and sedation 2 . Nevertheless, the implementation of nerve block as an invasive treatment is a complex procedure accompanied by the potential for complications, including infection, nerve damage, and anaphylaxis to anesthetics 7 . Therefore, exploring a safe, effective and simple new method is the goal of this study. Transcutaneous tibial nerve stimulation (TTNS) is a minimally invasive, safe and well-tolerated neuromodulation technique for lower urinary tract dysfunction 8 . It has been shown to treat overactive bladder (OAB) by stimulating the tibial nerve to achieve a limiting effect on the overactivity of the detrusor muscle, relieving the frequency and urgency of urination 9 – 12 . The symptoms of CRBD are similar to those of OAB 13 . TTNS may affect the incidence of CRBD, but no studies have been conducted on this topic. Therefore, we assume that TTNS can reduce the occurrence of CRBD. In the present study, we aimed to evaluate the preventive effect of TTNS on postoperative CRBD in patients who underwent urological surgery under general anesthesia. 2. Methods The present study was a prospective, randomized controlled study with a 1:1 control-to-trial-group ratio that followed the applicable CONSORT guidelines. It was approved (approval number: KJ2023-437-01) by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University and was also registered and reviewed in the China Clinical Trial Registry (registration number: ChiCTR2300078536) by the primary investigator (Zheng Xiangying) on 12/12/2023. The methods presented in the paper are identical to those used in the trial registration. Prior to their involvement in the study, written informed consent was obtained from all patients. 2.1. Study population Patients were recruited from December 2023 to June 2024. The inclusion criteria included elective urological surgery under general anesthesia and catheterization performed under anesthesia. American Society of Anesthesiologists (ASA) grade I-III; male; patients were 18 to 70 years of age and provided written informed consent. The exclusion criteria were combined cardiac pacemaker implantation, severe arrhythmia, epilepsy and other contraindications to transcutaneous electrical stimulation. The patients had a history of severe cardiovascular, renal, and liver diseases and cerebrovascular accidents. An infection at the skin patch site or previous surgical scar or a history of an indwelling catheter. The trial was terminated immediately when the patient was asked to withdraw without any reason, when a new patient was found to meet the exclusion criteria, or when there was a significant increase in blood pressure, a significant abnormality in heart rate, or discomfort during the trial. 2.2. Randomization, concealment, and blinding In this study, stratified block randomization was employed. Initially, eligible participants were stratified into three categories on the basis of the type of procedure: laparoscopic, transurethral, and percutaneous nephrolithotomy. These participants were then numbered according to age from youngest to oldest. Following the generation of random numbers via SPSS 22.0 software, the setup block length was set to 4, and the allocation ratio was set to 1:1. The patients were then divided into two groups: a control group and a TTNS group. The randomization protocol was placed in airtight envelopes by the original investigator, and the second investigator performed the intervention after the patient was admitted to the postanaesthesia care unit (PACU), according to group assignment. The assessors were two experienced physicians who were unaware of the group assignments and were not involved in the treatment of either group. Data statistics were also obtained by personnel not involved in the study to reduce experimental bias and increase the power of the results. At least 10% blinded bottom-envelope sampling was performed to ensure that the assignment was correct. The electrical stimulation parameter selected for the experimental intervention was the stimulation intensity, which was determined according to the patient's personality before the operation; that is, it caused muscle contraction without pain. Therefore, the subjects in the control group were blinded by connecting the electrical stimulation circuit normally but not receiving electrical stimulation. 2.3. Anesthetic management Upon arrival at the operating room, all patients underwent standard general anesthesia procedures. The vein channel was opened, and noninvasive blood pressure (BP), heart rate (HR), saturation of peripheral oxygen (SpO 2 ), electrocardiogram (EGG), and bispectral index (BIS) were monitored. At the same time, oxygen was administered to the mask, and the oxygen flow rate was set at 5 L/min. Anesthesia was induced with 0.05 mg/kg midazolam, 0.25 mg/kg etomidate, 0.6 mg/kg rocuronium and 0.5 µg/kg sufentanil. After intubation, the patient was mechanically ventilated. The respiratory parameters were adjusted to inspired oxygen flow rates of 1 to 2 L/min, tidal volumes of 6 to 8 ml/kg, respiratory rates of 12 to 14 times/min, end-tidal carbon dioxide concentrations of 35 to 45 mmHg, and peak airway pressures of no more than 30 cmH2O. Anesthesia was maintained with 4 to 12 mg/kg·h propofol and 0.15 to 0.2 µg/kg·min remifentanil via a continuous intravenous pump. Neuromuscular blockade was monitored when the BIS value was < 70, the BIS value was maintained between 40 and 60 during the operation, and intermittent administration of rocuronium maintained a train of four (TOF) counts ≤ 2. Catheterization was performed under anesthesia, and noninvasive blood pressure and heart rate were maintained at baseline ± 20% by adjusting the infusion speed and using vasoactive drugs. At the end of the procedure, intravenous anesthetic drugs were stopped, the patient was admitted to the PACU for close observation, and sugammadex 2 mg/kg was administered to reverse neuromuscular blockade. After the patient's level of consciousness and neuromuscular function (BIS > 90 and TOF ratio ≥ 0.9) were evaluated, the tracheal tube was removed. 2.4. Transcutaneous tibial nerve stimulation Before surgery, the patient was taught to recognize symptoms of CRBD, such as urinary urgency, pain or burning in the urethra or suprapubic region, and to personalize the intensity of stimulation (to cause muscle contraction without pain). Both groups in the PACU had corresponding tibial body surface areas (approximately three cross above the ankle in the rear) of the electrodes. The TTNS group was subjected to TTNS stimulation for 30 min, and the parameters were set as follows: pulse 200 µs, frequency 20/100 Hz alternating sparse-dense waves, and magnitude of the current that caused muscle contraction without pain. The control group was not stimulated with TTNS for 30 min, and the current circuit was normally connected, but no electrical stimulation was given. Postoperative analgesic use tramadol as a rescue. Tramadol was administered at a dose of 1 mg/kg if patients reported moderate to severe CRBD or if they described a visual analog scale (VAS) score of pain at the surgical site of 4 or more. 2.5. Outcome variables Various general characteristics of the patients, including age, body mass index (BMI), ASA classification and several comorbidities, such as hypertension and diabetes mellitus, were recorded in this study. The variables related to surgery and anesthesia included the duration of anesthesia, duration of surgery, size of catheter inserted and postoperative use of the analgesic pump. CRBD severity was assessed at 0, 1, 2, and 6 h after tracheal extubation. The first assessment was performed immediately after the patient was extubated to determine the classification of CRBD at 0 h after extubation. The severity of CRBD was categorized as follows: "none" if the patient did not report CRBD even when asked, "mild" if only disclosure was made when asked, "moderate" if the patient voluntarily mentioned it without any concomitant behavioral response, and "severe" if the patient voluntarily mentioned it without any concomitant behavioral response. These behavioral responses included attempts to remove the catheter, strong verbal responses, and flailing limbs. The primary endpoint of this study was defined as the occurrence of moderate or severe CRBD immediately following tracheal extubation. The secondary endpoint was the presence of moderate or severe CRBD at 1, 2, and 6 h after extubation. The severity of pain at the surgical site was evaluated at 0, 1, 2, and 6 hours after tracheal extubation using a VAS ranging from 0 to 10, with 0 representing no pain and 10 representing the maximum pain imaginable. The quality of the patient's postoperative recovery was assessed 24 h postoperatively via the Quality of Recovery-15 (QoR-15). The length of stay from admission to postoperative discharge was determined, the number of cases of dizziness, nausea, vomiting, agitation, delirium, and the use of pharmacologic remedies were recorded for postoperative patients, and the occurrence of adverse effects related to TTNS, such as arrhythmias and allergies, was assessed. 2.6. Sample size calculation This trial is a randomized controlled study, and the primary outcome indicator is the incidence of moderate-to-severe CRBD at 0 h after tracheal extubation, as a comparison of rates in two independent samples. On the basis of the findings of previous clinical studies, it was estimated that 60% of patients would develop moderate-to-severe CRBD following urological surgery. The hypothesis of the study was that the TTNS intervention would be able to reduce the incidence to 30% 3,4,13 . With a 2-sided significance level of 0.05 and a power of 0.9, the total sample size was calculated to be 106 cases via PASS2021 software. Considering a 10% loss to follow-up rate, a total of 118 study subjects were needed, which were randomly assigned at a 1:1 ratio, with 59 study subjects assigned to each group. 2.7. Statistical analysis Data are expressed as the means ± standard deviations, medians (lower quartiles, upper quartiles), and numbers (proportions), and relative risks (RRs) and 95% confidence intervals (95% CIs) were determined. The Shapiro‒Wilk test was used to assess whether continuous data conformed to a normal distribution. Independent t tests were used to test for normally distributed continuous variables. The Mann‒Whitney U test was used to compare nonnormally distributed continuous variables. The categorical variables were compared via the chi-square test or Fisher's exact test, and the relationships between ordered variables between two groups were analyzed via the Mann‒Whitney U test. If necessary, adjustments were made via the Bonferroni correction, and adjustments were considered significantly different at P < 0.0125. In other cases, P < 0.05 was considered statistically significant, whereas P < 0.001 was considered highly significant. The data were analyzed via the Statistical Package for the Social Sciences (SPSS, Version 27.0, IBM Corp, USA). 3. Results A total of 311 patients scheduled for urologic surgery were recruited for this study. Of these, 185 patients were excluded due to noncompliance with the inclusion and exclusion criteria, and 126 study subjects were randomly assigned. Following the grouping process, one patient was excluded because of a serious intraoperative cardiovascular event, and another was excluded because of postoperative refusal to participate in the trial. This resulted in a final sample of 62 patients in the TTNS group and 62 patients in the control group, as illustrated in Fig. 1 . A comparative analysis of the clinical characteristics of patients in both groups revealed no significant disparities ( P > 0.05), as outlined in Table 1 . These characteristics included age, BMI, ASA classification, underlying disease, duration of anesthesia, duration of surgery, surgical approach, postoperative analgesic pump utilization rate, and catheter size. Table 1 Clinical Characteristics. Control group (n = 62) TTNS group (n = 62) P -value Age, years 52.10 ± 11.339 52.50 ± 10.228 0.836 BMI, kg/m 2 26.23(24.08,29.41) 26.04(23.43,29.15) 0.615 ASA PS, Class Ⅰ/Ⅱ/Ⅲ 9 (14.5%)/42 (67.7%)/11 (17.7%) 5 (8.1%)/51 (82.3%)/6 (9.7%) 0.841 Hypertension 32 (51.6%) 39 (62.9%) 0.204 Diabetes mellitus 22 (35.5%) 19 (30.6%) 0.567 Anesthesia time, minutes 100 (79.5 ~ 141) 100.5 (77 ~ 122.25) 0.612 Operative time, minutes 87.5 (60 ~ 120) 81 (61.5 ~ 106.25) 0.615 Postoperative analgesia pump 12 (19.4%) 10 (16.1%) 0.638 Foley catheter diameter (Fr) < 18/≥ 18 6(9.7%)/56(90.3%) 8(12.9%)/54(87.1%) 0.570 Data were expressed using mean ± standard deviation, median (lower quartile, upper quartile), and numbers (proportions). Control group, accepting connected circuits but no current as placebo; TTNS group, connect the circuit and give electrical stimulation for 30 min. Abbreviation: BMI, Body Mass Index; ASA, American Society of Anesthesiologists. As illustrated in Fig. 2 , moderate to severe CRBD was observed at 0, 1, 2, and 6 h following tracheal extubation in both groups. TTNS stimulation resulted in a statistically significant reduction in the incidence of moderate to severe CRBD at 0 h after tracheal extubation compared with the control group [9 (14.50%) vs. 24 (38.7%), P = 0.002, 95% CI = (0.190–0.741), RR = 0.375]. A comparison of the incidence of moderate to severe CRBD at 1 h after extubation [2 (3.2%) vs. 18 (29.0%), P < 0.001, 95% CI = (0.027–0.459), RR = 0.111] revealed a statistically significant decrease in the control group. Similarly, a decrease in the incidence of moderate to severe CRBD at 2 h after tracheal extubation was observed [1 (1.6%) vs. 11 (17.7%), P = 0.002, 95% CI = (0.012–0.683), RR = 0.091]. However, a lack of statistically significant variation was identified in the occurrence of moderate or severe CRBD at 6 h following extubation between the two groups [2 (3.2%) vs. 4 (6.5%), P = 0.403, 95% CI = (0.095–2.631), RR = 0.5]. The CRBD grades at 0, 1, 2, and 6 h following tracheal extubation in the two groups are illustrated in Fig. 3 . A comparison of the two groups revealed that, in contrast to that in the control group, the severity of CRBD at 0, 1, 2, and 6 h following tracheal extubation was significantly lower in the TTNS group. This reduction was significant at 1, 2, and 6 hours ( P = 0.017, P < 0.001, P < 0.001, P < 0.001, respectively). The 0-, 1-, 2-, and 6-h VAS scores following tracheal extubation were meticulously documented (Table 2 ). A comparative analysis of VAS scores revealed a decrease in pain levels in the TTNS group relative to the control group at 0, 1, and 2 h following tracheal extubation, whereas no statistically significant differences were observed at 6 h: 0 h posttracheal extubation [2.05 (1.075 ~ 2.7) vs. 2.5 (1.7 ~ 2.8525), P = 0.009]; 1 h [2.5 (1.275 ~ 2.9) vs. 2.85 (1.725 ~ 3.425), P = 0.012]; 2 h [2.4 (1.15 ~ 2.7) vs. 3.0 (1.275 ~ 3.4), P = 0.013]; and 6 h [2.9 (1.375 ~ 3.3) vs. 3.2 (1.275 ~ 3.625), P = 0.051]. Table 2 Postoperative pain, postoperative medication, postoperative recovery and adverse effects in urologic surgical procedures are sufficient. Control group (n = 62) TTNS group (n = 62) P- value VAS 0 h after tracheal extubation 2.5 (1.7 ~ 2.8525) 2.05 (1.075 ~ 2.7) 0.009 1 h after tracheal extubation 2.85 (1.725 ~ 3.425) 2.5 (1.275 ~ 2.9) 0.012 2 h after tracheal extubation 3.0 (1.275 ~ 3.4) 2.4 (1.15 ~ 2.7) 0.013 6 h after tracheal extubation 3.2 (1.275 ~ 3.625) 2.9 (1.375 ~ 3.3) 0.051 QoR-15 128.74 ± 7.038 135.44 ± 5.838 < 0.001 Length of hospital stay, days 10 (7 ~ 15) 9 (6 ~ 13) 0.231 Postoperative dizziness 4 (6.5%) 2 (3.2%) 0.403 Postoperative nausea 18 (29%) 6 (9.7%) 0.006 Postoperative vomiting 10 (16.1%) 4 (6.5%) 0.089 Postoperative agitation 5 (8.1%) 1 (1.6%) 0.094 Postoperative delirium 0 (0%) 0 (0%) > 0.999 Medication remediation 36 (58.1%) 17 (27.4%) 0.999 Allergies 0 (0%) 0 (0%) > 0.999 Data were expressed using mean ± standard deviation, median (lower quartile, upper quartile), and numbers (proportions). Control group, accepting connected circuits but no current as placebo; TTNS group, connect the circuit and give electrical stimulation for 30 min. Abbreviation: VAS, visual analog scale; QoR-15, Quality of Recovery-15. A comprehensive evaluation was conducted to assess postoperative recovery and other pertinent aspects of the two groups (Table 2 ). Compared with those in the control group, the patients in the TTNS group had significantly higher postoperative 24-hour QoR-15 scores (135.44 ± 5.838 vs. 128.74 ± 7.038, P < 0.001). Furthermore, the incidence of postoperative nausea [6 (9.7%) vs. 18 (29%), P = 0.006] and medication remediation [17 (27.4%) vs. 36 (58.1%), P < 0.001] in patients was significantly lower than that in the control group. A meticulous analysis revealed no statistically significant disparity in the duration of hospital stay between the two groups [9 (6 ~ 13) days vs. 10 (7 ~ 15) days, P = 0.231]. The incidence of dizziness [2 (3.2% vs. 4 (6.5%), P = 0.403], vomiting [4 (6.5%) vs. 10 (16.1%), P = 0.089], and agitation [1 (1.6% vs. 5 (8.1%), P = 0.094] did not significantly differ between the two groups. Postoperative delirium or adverse events related to TTNS, such as arrhythmia, allergy, or skin discomfort at the electrode site, were not observed in any patient in either group. A comparative analysis was conducted to ascertain the impact of the surgical approach on the incidence of moderate to severe CRBD following tracheal extubation (Fig. 4 ). The study revealed that in laparoscopic surgery, the observed difference in incidence between the TTNS group and the control group did not reach statistical significance [3 (12.5%) vs. 5 (20.8%), P = 0.439]. However, when the transurethral and percutaneous nephrolithotomy cohorts were analyzed, statistically significant differences were observed between the TTNS group and the control group: transurethral [3 (15.0%) vs. 9 (45.0%), P = 0.038] and percutaneous nephrolithotomy [3 (16.7%) vs. 10 (55.6%), P = 0.015]. 4. Discussion In our study, TTNS intervention was found to significantly reduce the incidence of moderate or severe CRBD at 0, 1, and 2 hours after tracheal extubation for urologic surgery, and it could change the grade of CRBD at 0, 1, 2, and 6 hours after tracheal extubation. In addition, the VAS scores of patients in the TTNS group were significantly lower than those in the control group at 0, 1, and 2 hours after tracheal extubation, and the postoperative 24-hour QoR-15 scores of patients in the TTNS group were significantly greater than those in the control group. We also found no adverse effects associated with the TTNS intervention. TTNS is a technique that involves the modulation of the tibial nerve, which contains L4–S3 nerve fibers from the same segment as the S2–S4 nerve fibers that innervate the bladder 14 . Of particular relevance are the S3 nerve fibers, which contain sensory fibers from the pelvic floor and parasympathetic motor efferents to the detrusor muscle, as well as motor fibers from the pelvic sphincter and pelvic floor muscles. These motor fibers primarily innervate the detrusor and levator muscles. The use of TTNS in the treatment of lower urinary tract dysfunctions (LUTDs), such as OAB, has been well documented 15 . A meta-analysis by Zifu Yu et al. 16 evaluated the quality of evidence for the role of TTNS in improving maximal urethral pressure (MDP) in patients with neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI). Randomized controlled studies by Ya-Xiong Xu et al. 17 and Argyrios Stampas et al. 18 Both studies reported that TTNS can be used to treat the clinical symptoms of OAB and has a favorable safety profile. Electrical stimulation of the afferent nerves of the posterior tibial nerve has been demonstrated to inhibit reflexive bladder activity. This inhibition occurs through the suppression of the upward pathway of the supraspinal pathway in the voiding reflex or the periaqueductal gray‒pontine micturition center (PMC) 19 , 20 . Additionally, electrical stimulation may directly inhibit the excitability of neurons in the sacral medullary pathway, thereby contributing to the inhibition of bladder activity 21 , 22 . The study by Todd Yecies et al. 22 also reported that these neuromodulatory effects can occur while stimulation is ongoing and continue to be suppressed after 30 minutes of stimulation. The studies by Sibel Canbaz Kabay et al. 23 and G Amarenco et al. 24 found that tibial nerve stimulation improves acute urodynamics instantly and thus can be used to attenuate the onset of CRBD in the immediate postoperative period. According to the gating doctrine, the application of high-frequency electrical stimulation initially activates myelinated A-β fibers. These fibers possess a lower threshold and exhibit faster conduction velocities. Additionally, stimulation triggers the premature activation of glial cells, resulting in the inhibition of conduction in class C fibers 25 . Brian Wodlinger et al. reported that high-frequency stimulation may also reduce nociceptive sensitization for analgesia by blocking C nerve fiber activity 26 . Research conducted by Jason P Paquette et al. 27 and Zhonghan Zhou et al. 28 These findings indicate that the activation of class C nerve fibers by low-frequency electrical stimulation can induce bladder inhibition. However, experiments by A Sato et al. 29 and Michelle Yu et al. 30 Both studies reported that repeated application of high-frequency and low-frequency tibial nerve stimulation costimulated both to produce better inhibition and modulation of bladder function. Consequently, the alternating application of high- and low-frequency sparse wave stimulation of the tibial nerve may prove effective in the management of postoperative CRBD. Recent studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) facilitates the release of endogenous opioid peptides, reduces the level of inflammatory cytokines, and produces analgesia 31 , 32 . The activation of µ-opioid receptors is induced by low-frequency electrical stimulation, whereas the activation of δ-opioid receptors is induced by high-frequency stimulation 33 , 34 . Opioid medications, including tramadol and dizocine, have demonstrated clear efficacy in the treatment of CRBD 35 , 36 . Consequently, the potential of TTNS to mitigate the severity of CRBD is a promising avenue for further research. The present study demonstrated that TTNS significantly reduced the severity of postoperative CRBD in patients who underwent urologic surgery. Notably, there was no statistically significant difference in the incidence of moderate-to-severe 6-hour CRBD between the TTNS group and the control group. However, a statistically significant difference was observed in the overall severity of CRBD. This phenomenon can be attributed to the observed reduction in mild CRBD, resulting in a relative increase in the proportion of patients with no CRBD. Consequently, TTNS has been shown to play a beneficial role in mitigating the severity of CRBD. The QoR-15 assessment revealed a substantial improvement in patient recovery quality following the TTNS intervention. The tibial nerve stimulation sites selected for this study (posterior to the medial ankle joint and approximately three transverse fingers above it) are located at the Chinese medicine acupuncture points belonging to the BL59 and BL60 in the bladder meridian of foot-taiyang. The stimulation of these two points in acupuncture treatment studies has been shown to shorten the awakening time of patients, improve postoperative analgesia, and contribute to the rapid recovery of patients after surgery 37 . The present study revealed that the TTNS group presented reduced postoperative VAS scores and a diminished prevalence of nausea. Moreover, the QoR-15 assessment demonstrated a substantial improvement in the quality of patient recovery following TTNS intervention. This phenomenon may be attributed to a reduction in the incidence of postoperative complications, which is a hallmark of enhanced recovery. This finding is pivotal for achieving a favorable prognosis, suggesting that a reduction in CRBD severity after TTNS intervention may provide substantial benefit. A preponderance of extant research has demonstrated the infrequent occurrence of deleterious effects concomitant with TENS 38 . The present study reports no adverse events that are unequivocally attributable to TENS. Consequently, 30 minutes of postoperative stimulation employing current sizes with pulses of 200 µs and alternating sparse-dense waves at a frequency of 20/100 hertz, which induce muscle contraction without pain, appears to be safe. However, the limited sample size of our trial precluded us from assessing the incidence of other serious events or generalizing to other intervention parameters. The efficacy and safety of TTNS intervention in reducing moderate to severe CRBD following transurethral or percutaneous nephrolithotomy have been demonstrated. However, the intervention did not have a significant effect on the postoperative period after laparoscopic surgery, likely due to the timing of the intervention, which could have been optimized. In this study, TTNS was initiated at the beginning of the postoperative period to improve acute urodynamics. However, because of its clinical use in the treatment of other bladder disorders, it is generally necessary to continue for several weeks, and the stimulation parameters have not been optimally selected 14 . Furthermore, the duration of intervention in studies of transcutaneous electrical stimulation of acupoints for CRBD varies 3 , 39 . Consequently, further trials are necessary to determine the optimal stimulation time and parameters. Additionally, a larger sample size is needed to determine the effectiveness of this protocol in preventing postoperative CRBD. It is imperative to acknowledge the limitations of this study. First, although the use of an alternating sparse-dense waves intervention with pulses of 200 µs and frequencies of 20/100 Hz resulted in moderate or greater reductions in CRBD, we cannot assert that this particular stimulation parameter is the optimal amount to prevent CRBD. Second, we performed TTNS at the conclusion of the procedure and were unable to ascertain whether this was the most effective time to prevent CRBD. Finally, the limited sample size of our trial precluded our ability to assess the incidence of other serious events. Consequently, further research is necessary to ascertain the most effective stimulation parameters and the optimal timing of TTNS intervention. Additionally, a larger sample size is needed to ascertain the efficacy of this regimen in preventing postoperative CRBD. In conclusion, patients receiving TTNS presented a reduced incidence of moderate or severe CRBD following urologic surgery. Furthermore, patients who received TTNS exhibited increased postoperative analgesia and improved postoperative recovery. These findings imply that the use of TTNS may be an effective strategy for mitigating postoperative CRBD in urologic surgery. Future studies should focus on expanding the sample size, improving the duration of intervention, and adjusting the stimulation parameters of TTNS to provide more comprehensive and reliable results. 5. Conclusions In this study, we demonstrated that TTNS with pulses of 200 µs and alternating sparse-dense waves at a frequency of 20/100 Hz given for 30 min upon entering the recovery room can effectively reduce the occurrence of moderate-to-severe CRBD and its severity after general anesthesia in male patients with urology, strengthen the effect of postoperative analgesia, reduce the occurrence of postoperative nausea, and improve the quality of postoperative recovery. Moreover, it does not increase the occurrence of postoperative adverse events. Abbreviations CRBD Catheter-related bladder discomfort TTNS Transcutaneous tibial nerve stimulation OAB Overactive bladder ASA American Society of Anesthesiologists PACU Postanesthesia care unit BP Blood pressure HR Heart rate SpO 2 Saturation of peripheral oxygen EGG Electrocardiogram BIS Bispectral index TOF Train of four VAS visual analogue scale BMI body mass index QoR-15 Quality of recovery-15 LUTD Lower urinary tract dysfunctions MDP Maximal urethral pressure NLUTD Neurogenic lower urinary tract dysfunction SCI Spinal cord injury PMC Periaqueductal gray-pontine micturition center TENS transcutaneous electrical nerve stimulation Declarations Ethics approval and consent to participate The present study was approved (approval number: KJ2023-437-01) by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University, and written informed consent was obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available owing to the privacy of the patient data involved but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was conducted at the First Affiliated Hospital of Shihezi University and was supported by the Science and Technology Program of the Corps (NO. 2022ZD037, NO. 2022ZD077). Author contributions X.Z. helped in the conception and design of the work, acquired and analyzed the data, helped interpret the data, was a major contributor in writing the manuscript, revised the manuscript, and approved the final version of the manuscript. Y.L. helped in the conception and design of the work, acquired and analyzed the data, helped interpret the data, was a major contributor in writing the manuscript, and had final approval of this version. T.W. was involved in the acquisition and analysis of the data, interpretation of the data, and final review of this version. C.D. helped in the conception and design of the work, helped interpret the data, helped revise the article, and had final approval of this version. Acknowledgments None References Chen, H. et al. Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study. BMC Anesthesiol 20, 267 (2020). Bai, Y. et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. J Endourol 29, 640–649 (2015). Liang, D. et al. The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate. Evid Based Complement Alternat Med 2021, 6691459 (2021). Park, J.-Y. et al. Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor: A double-blind, randomized, placebo-controlled study. Journal of Clinical Anesthesia 89, 111191 (2023). Li, J. & Liao, R. Prevention of catheter-related bladder discomfort – pudendal nerve block with ropivacaine versus intravenous tramadol: study protocol for a randomized controlled trial. Trials 17, 448 (2016). Bao, X. et al. The efficacy of peripheral nerve block on postoperative catheter-related bladder discomfort in males: A systematic review and meta-analysis. Front Surg 10, 1099628 (2023). Li, S., Li, P., Wang, R. & Li, H. Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis. Eur J Clin Pharmacol 78, 897–906 (2022). Agost-González, A. et al. Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review. Healthcare (Basel) 9, 879 (2021). Kozma, B., Majoros, A., Pytel, Á., Póka, R. & Takács, P. Efficacy of the percutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms. Orv Hetil 159, 1735–1740 (2018). Park, E. et al. The long-lasting post-stimulation inhibitory effects of bladder activity induced by posterior tibial nerve stimulation in unanesthetized rats. Sci Rep 10, 19897 (2020). Al-Danakh, A. et al. Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines. Parkinsons Dis 2022, 2700227 (2022). Abello, A. & Das, A. K. Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects. Ther Adv Urol 10, 165–173 (2018). Agarwal, A. et al. An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study. Anesthesia & Analgesia 105, 1454–1457 (2007). Li, X., Li, X. & Liao, L. Mechanism of Action of Tibial Nerve Stimulation in the Treatment of Lower Urinary Tract Dysfunction. Neuromodulation: Technology at the Neural Interface 27, 256–266 (2024). Lightner, D. J., Gomelsky, A., Souter, L. & Vasavada, S. P. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. The Journal of Urology (2019) doi:10.1097/JU.0000000000000309. Yu, Z. et al. Effects of non-invasive or minimally invasive neuromodulation techniques on neurogenic lower urinary tract dysfunction after spinal cord injury: A network meta-analysis. Arch Phys Med Rehabil S0003-9993(24)01420–5 (2024) doi:10.1016/j.apmr.2024.12.016. Xu, Y.-X. et al. Efficacy of the combination of transcutaneous tibial nerve stimulation and mirabegron in women with overactive bladder in a prospective randomized controlled trial. Sci Rep 14, 27248 (2024). Stampas, A., Korupolu, R., Lee, K. H., Salazar, B. & Khavari, R. Reduction of Overactive Bladder Medications in Spinal Cord Injury With Self-Administered Neuromodulation: A Randomized Trial. J Urol 212, 800–810 (2024). Lyon, T. D. et al. Pudendal but not tibial nerve stimulation inhibits bladder contractions induced by stimulation of pontine micturition center in cats. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 310, R366–R374 (2016). Xiao, Z. et al. Somatic modulation of spinal reflex bladder activity mediated by nociceptive bladder afferent nerve fibers in cats. Am J Physiol Renal Physiol 307, 673–679 (2014). Gupta, P., Ehlert, M. J., Sirls, L. T. & Peters, K. M. Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update. Curr Urol Rep 16, 4 (2015). Yecies, T. et al. Spinal interneuronal mechanisms underlying pudendal and tibial neuromodulation of bladder function in cats. Exp Neurol 308, 100–110 (2018). Kabay, S. C., Kabay, S., Yucel, M. & Ozden, H. Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson’s disease. Neurourol Urodyn 28, 62–67 (2009). Amarenco, G. et al. Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169, 2210–2215 (2003). Mendell, L. M. Constructing and deconstructing the gate theory of pain. Pain 155, 210–216 (2014). Wodlinger, B., Rashid, S. & Durand, D. M. Block of peripheral pain response by high-frequency sinusoidal stimulation. Neuromodulation 16, 312–317 (2013). Paquette, J. P. & Yoo, P. B. Recruitment of unmyelinated C-fibers mediates the bladder-inhibitory effects of tibial nerve stimulation in a continuous-fill anesthetized rat model. Am J Physiol Renal Physiol 317, 163–171 (2019). Zhou, Z., Wang, X., Li, X. & Liao, L. Transdermal tibial nerve optogenetic stimulation targeting C-fibers. Front Physiol 14, 1224088 (2023). Sato, A., Sato, Y. & Schmidt, R. F. Reflex bladder activity induced by electrical stimulation of hind limb somatic afferents in the cat. J Auton Nerv Syst 1, 229–241 (1980). Yu, M. et al. An excitatory reflex from the superficial peroneal nerve to the bladder in cats. Am J Physiol Renal Physiol 313, 1161–1168 (2017). do Carmo Almeida, T. C. et al. Effects of Transcutaneous Electrical Nerve Stimulation on Proinflammatory Cytokines: Systematic Review and Meta-Analysis. Mediators Inflamm 2018, 1094352 (2018). Ulloa, L., Quiroz-Gonzalez, S. & Torres-Rosas, R. Nerve Stimulation: Immunomodulation and Control of Inflammation. Trends Mol Med 23, 1103–1120 (2017). Vance, C. G. T., Dailey, D. L., Rakel, B. A. & Sluka, K. A. Using TENS for pain control: the state of the evidence. Pain Manag 4, 197–209 (2014). Sluka, K. A., Bjordal, J. M., Marchand, S. & Rakel, B. A. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther 93, 1397–1402 (2013). Agarwal, A., Yadav, G., Gupta, D., Singh, P. K. & Singh, U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth 101, 506–510 (2008). Zhang, G.-F. et al. Effects of dezocine for the prevention of postoperative catheter-related bladder discomfort: a prospective randomized trial. Drug Des Devel Ther 13, 1281–1288 (2019). YANG, Y. et al. Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery. J Clin Anesthesiol 34, 11–15 (2018). Chen, Y. et al. The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis. Int J Surg 109, 1430–1438 (2023). Zhang, Y. et al. Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial. Clin Interv Aging 17, 1751–1760 (2022). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 15 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 19 Jun, 2025 Reviews received at journal 03 Jun, 2025 Reviewers agreed at journal 25 May, 2025 Reviews received at journal 05 May, 2025 Reviewers agreed at journal 01 May, 2025 Reviewers invited by journal 03 Apr, 2025 Editor assigned by journal 03 Apr, 2025 Editor invited by journal 03 Apr, 2025 Submission checks completed at journal 03 Apr, 2025 First submitted to journal 19 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6259020","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":446217190,"identity":"54862f27-138c-493e-b6ad-cff8c191840a","order_by":0,"name":"Xiangying Zheng","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Xiangying","middleName":"","lastName":"Zheng","suffix":""},{"id":446217191,"identity":"4bffb7dc-3f14-414b-b6dc-84e91a185aaa","order_by":1,"name":"Yuwen Liu","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Yuwen","middleName":"","lastName":"Liu","suffix":""},{"id":446217192,"identity":"55644e53-54d7-4c45-b519-4c7db9349177","order_by":2,"name":"Tao Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wei","suffix":""},{"id":446217193,"identity":"7005cc87-3a72-4ade-806b-d8afdf0a9968","order_by":3,"name":"Chao Deng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYDCCA0AsYWDDY9/e2PjwA/FaCtJkDHgONxtLEK2F4cNhGwOJ9DYBHmJ08B0/fk3CwoCZx1zyYRuDBIOdnG4DAS2SZ3LKJCQM2HgsZye2PShgSDY2O0BAi8ENnjSgFh4ehtuJ7QYSDAcStxGpRYKH4ebBNiBJlBb2Y0AtBjwGNxiJ1AL0C7OFhEECj2RPIjCQDYjwCzDEHt6W+PPfnp/9+MOHHyrs5AhqYWDgMZFGxKABQeUgwP74I3HpZBSMglEwCkYsAADM/UGTZd8McwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Shihezi University","correspondingAuthor":true,"prefix":"","firstName":"Chao","middleName":"","lastName":"Deng","suffix":""}],"badges":[],"createdAt":"2025-03-19 07:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6259020/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6259020/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-32254-w","type":"published","date":"2025-12-15T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81936176,"identity":"8b970bea-c43f-450d-9079-8e3b74af2176","added_by":"auto","created_at":"2025-05-05 06:05:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":91423,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram. The control group comprised patients who received the connecting circuit but not electrical stimulation, thereby serving as a placebo. The TTNS group consisted of patients who received 30 minutes of TTNS stimulation.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6259020/v1/2848e917f9336c4b1f1f9c33.jpg"},{"id":81936115,"identity":"0cac9891-b8e4-4782-81d9-6e10877a26d1","added_by":"auto","created_at":"2025-05-05 06:03:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27462,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the incidence of moderate-to-severe CRBD at 0, 1, 2, and 6 hours after tracheal extubation in the TTNS group (purple bars) versus the control group (blue bars). CRBD, catheter-related bladder discomfort.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6259020/v1/54c03f3b336969035cd73262.jpg"},{"id":81936199,"identity":"a0258c39-068b-43a8-882f-9bffcdd0cdd9","added_by":"auto","created_at":"2025-05-05 06:05:37","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54830,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of CRBD grading between the TTNS group and the control group at 0, 1, 2, and 6 h after tracheal extubation; none CRBD (purple bars), mild CRBD (green bars), moderate CRBD (blue bars), severe CRBD (gray bars).\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6259020/v1/ac156ac42360572153d4eebb.jpg"},{"id":81936158,"identity":"dde5172c-3d59-478b-b245-0e9d45481d42","added_by":"auto","created_at":"2025-05-05 06:04:45","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":19510,"visible":true,"origin":"","legend":"\u003cp\u003eA comparative analysis was conducted to ascertain the incidence of moderate or severe CRBD at 0 h following tracheal extubation in the TTNS group (purple bars) and the control group (blue bars) under various surgical modalities.\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6259020/v1/dc3464ad16f44a254684988b.jpg"},{"id":98813818,"identity":"f32efa69-0886-4eed-9208-b7465c89acb0","added_by":"auto","created_at":"2025-12-22 15:59:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":873406,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6259020/v1/e891f4e1-ffe5-4e98-97ae-fac92d20be73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Influence of Transcutaneous Tibial Nerve Stimulation on Postoperative Catheter-Related Bladder Discomfort in Urology: A Prospective, Randomized, Controlled Trial","fulltext":[{"header":"Summary of key points","content":"\u003cul\u003e\n \u003cli\u003eQuestion: Does transcutaneous tibial nerve stimulation (TTNS) reduce the incidence of postoperative catheter-related bladder discomfort (CRBD) in male patients who are receiving general anesthesia for urologic surgery?\u003c/li\u003e\n \u003cli\u003eFindings: In male patients undergoing general anesthesia for urologic surgery, the postoperative administration of TTNS for 30 min reduced the incidence of moderate-to-severe CRBD, enhanced postoperative analgesia, and improved the quality of patients\u0026apos; postoperative recovery without evidence of significant adverse effects.\u003c/li\u003e\n \u003cli\u003eMeaning: TTNS may be an effective way to reduce the incidence of postoperative moderate to severe CRBD in male patients who are receiving general anesthesia for urologic surgery.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eCatheter-related bladder discomfort (CRBD) is a common adverse reaction following surgical procedures. However, the use of an indwelling catheter is often necessary for many surgical patients during or after the procedure \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. CRBD occurs in 47\u0026ndash;90% of patients after general anesthesia, and 44%-67% of patients will develop to moderate-to-severe CRBD \u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. CRBD tends to trigger emergence agitation, which can result in pain and anxiety, an increased risk of postoperative complications, and prolonged hospitalization \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Currently, no ideal clinical solution for CRBD exists, and medications are ineffective in preventing and treating CRBD, resulting in a high incidence of side effects such as dry mouth, nausea and sedation\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Nevertheless, the implementation of nerve block as an invasive treatment is a complex procedure accompanied by the potential for complications, including infection, nerve damage, and anaphylaxis to anesthetics \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Therefore, exploring a safe, effective and simple new method is the goal of this study.\u003c/p\u003e \u003cp\u003eTranscutaneous tibial nerve stimulation (TTNS) is a minimally invasive, safe and well-tolerated neuromodulation technique for lower urinary tract dysfunction \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. It has been shown to treat overactive bladder (OAB) by stimulating the tibial nerve to achieve a limiting effect on the overactivity of the detrusor muscle, relieving the frequency and urgency of urination \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The symptoms of CRBD are similar to those of OAB \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. TTNS may affect the incidence of CRBD, but no studies have been conducted on this topic. Therefore, we assume that TTNS can reduce the occurrence of CRBD.\u003c/p\u003e \u003cp\u003eIn the present study, we aimed to evaluate the preventive effect of TTNS on postoperative CRBD in patients who underwent urological surgery under general anesthesia.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e The present study was a prospective, randomized controlled study with a 1:1 control-to-trial-group ratio that followed the applicable CONSORT guidelines. It was approved (approval number: KJ2023-437-01) by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University and was also registered and reviewed in the China Clinical Trial Registry (registration number: ChiCTR2300078536) by the primary investigator (Zheng Xiangying) on 12/12/2023. The methods presented in the paper are identical to those used in the trial registration. Prior to their involvement in the study, written informed consent was obtained from all patients.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study population\u003c/h2\u003e \u003cp\u003ePatients were recruited from December 2023 to June 2024. The inclusion criteria included elective urological surgery under general anesthesia and catheterization performed under anesthesia. American Society of Anesthesiologists (ASA) grade I-III; male; patients were 18 to 70 years of age and provided written informed consent. The exclusion criteria were combined cardiac pacemaker implantation, severe arrhythmia, epilepsy and other contraindications to transcutaneous electrical stimulation. The patients had a history of severe cardiovascular, renal, and liver diseases and cerebrovascular accidents. An infection at the skin patch site or previous surgical scar or a history of an indwelling catheter. The trial was terminated immediately when the patient was asked to withdraw without any reason, when a new patient was found to meet the exclusion criteria, or when there was a significant increase in blood pressure, a significant abnormality in heart rate, or discomfort during the trial.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Randomization, concealment, and blinding\u003c/h2\u003e \u003cp\u003eIn this study, stratified block randomization was employed. Initially, eligible participants were stratified into three categories on the basis of the type of procedure: laparoscopic, transurethral, and percutaneous nephrolithotomy. These participants were then numbered according to age from youngest to oldest. Following the generation of random numbers via SPSS 22.0 software, the setup block length was set to 4, and the allocation ratio was set to 1:1. The patients were then divided into two groups: a control group and a TTNS group.\u003c/p\u003e \u003cp\u003eThe randomization protocol was placed in airtight envelopes by the original investigator, and the second investigator performed the intervention after the patient was admitted to the postanaesthesia care unit (PACU), according to group assignment. The assessors were two experienced physicians who were unaware of the group assignments and were not involved in the treatment of either group. Data statistics were also obtained by personnel not involved in the study to reduce experimental bias and increase the power of the results. At least 10% blinded bottom-envelope sampling was performed to ensure that the assignment was correct. The electrical stimulation parameter selected for the experimental intervention was the stimulation intensity, which was determined according to the patient's personality before the operation; that is, it caused muscle contraction without pain. Therefore, the subjects in the control group were blinded by connecting the electrical stimulation circuit normally but not receiving electrical stimulation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Anesthetic management\u003c/h2\u003e \u003cp\u003eUpon arrival at the operating room, all patients underwent standard general anesthesia procedures. The vein channel was opened, and noninvasive blood pressure (BP), heart rate (HR), saturation of peripheral oxygen (SpO\u003csub\u003e2\u003c/sub\u003e), electrocardiogram (EGG), and bispectral index (BIS) were monitored. At the same time, oxygen was administered to the mask, and the oxygen flow rate was set at 5 L/min. Anesthesia was induced with 0.05 mg/kg midazolam, 0.25 mg/kg etomidate, 0.6 mg/kg rocuronium and 0.5 \u0026micro;g/kg sufentanil. After intubation, the patient was mechanically ventilated. The respiratory parameters were adjusted to inspired oxygen flow rates of 1 to 2 L/min, tidal volumes of 6 to 8 ml/kg, respiratory rates of 12 to 14 times/min, end-tidal carbon dioxide concentrations of 35 to 45 mmHg, and peak airway pressures of no more than 30 cmH2O. Anesthesia was maintained with 4 to 12 mg/kg\u0026middot;h propofol and 0.15 to 0.2 \u0026micro;g/kg\u0026middot;min remifentanil via a continuous intravenous pump. Neuromuscular blockade was monitored when the BIS value was \u0026lt;\u0026thinsp;70, the BIS value was maintained between 40 and 60 during the operation, and intermittent administration of rocuronium maintained a train of four (TOF) counts\u0026thinsp;\u0026le;\u0026thinsp;2. Catheterization was performed under anesthesia, and noninvasive blood pressure and heart rate were maintained at baseline\u0026thinsp;\u0026plusmn;\u0026thinsp;20% by adjusting the infusion speed and using vasoactive drugs. At the end of the procedure, intravenous anesthetic drugs were stopped, the patient was admitted to the PACU for close observation, and sugammadex 2 mg/kg was administered to reverse neuromuscular blockade. After the patient's level of consciousness and neuromuscular function (BIS\u0026thinsp;\u0026gt;\u0026thinsp;90 and TOF ratio\u0026thinsp;\u0026ge;\u0026thinsp;0.9) were evaluated, the tracheal tube was removed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Transcutaneous tibial nerve stimulation\u003c/h2\u003e \u003cp\u003eBefore surgery, the patient was taught to recognize symptoms of CRBD, such as urinary urgency, pain or burning in the urethra or suprapubic region, and to personalize the intensity of stimulation (to cause muscle contraction without pain). Both groups in the PACU had corresponding tibial body surface areas (approximately three cross above the ankle in the rear) of the electrodes. The TTNS group was subjected to TTNS stimulation for 30 min, and the parameters were set as follows: pulse 200 \u0026micro;s, frequency 20/100 Hz alternating sparse-dense waves, and magnitude of the current that caused muscle contraction without pain. The control group was not stimulated with TTNS for 30 min, and the current circuit was normally connected, but no electrical stimulation was given. Postoperative analgesic use tramadol as a rescue. Tramadol was administered at a dose of 1 mg/kg if patients reported moderate to severe CRBD or if they described a visual analog scale (VAS) score of pain at the surgical site of 4 or more.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Outcome variables\u003c/h2\u003e \u003cp\u003eVarious general characteristics of the patients, including age, body mass index (BMI), ASA classification and several comorbidities, such as hypertension and diabetes mellitus, were recorded in this study. The variables related to surgery and anesthesia included the duration of anesthesia, duration of surgery, size of catheter inserted and postoperative use of the analgesic pump.\u003c/p\u003e \u003cp\u003eCRBD severity was assessed at 0, 1, 2, and 6 h after tracheal extubation. The first assessment was performed immediately after the patient was extubated to determine the classification of CRBD at 0 h after extubation. The severity of CRBD was categorized as follows: \"none\" if the patient did not report CRBD even when asked, \"mild\" if only disclosure was made when asked, \"moderate\" if the patient voluntarily mentioned it without any concomitant behavioral response, and \"severe\" if the patient voluntarily mentioned it without any concomitant behavioral response. These behavioral responses included attempts to remove the catheter, strong verbal responses, and flailing limbs. The primary endpoint of this study was defined as the occurrence of moderate or severe CRBD immediately following tracheal extubation. The secondary endpoint was the presence of moderate or severe CRBD at 1, 2, and 6 h after extubation.\u003c/p\u003e \u003cp\u003eThe severity of pain at the surgical site was evaluated at 0, 1, 2, and 6 hours after tracheal extubation using a VAS ranging from 0 to 10, with 0 representing no pain and 10 representing the maximum pain imaginable. The quality of the patient's postoperative recovery was assessed 24 h postoperatively via the Quality of Recovery-15 (QoR-15). The length of stay from admission to postoperative discharge was determined, the number of cases of dizziness, nausea, vomiting, agitation, delirium, and the use of pharmacologic remedies were recorded for postoperative patients, and the occurrence of adverse effects related to TTNS, such as arrhythmias and allergies, was assessed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Sample size calculation\u003c/h2\u003e \u003cp\u003eThis trial is a randomized controlled study, and the primary outcome indicator is the incidence of moderate-to-severe CRBD at 0 h after tracheal extubation, as a comparison of rates in two independent samples. On the basis of the findings of previous clinical studies, it was estimated that 60% of patients would develop moderate-to-severe CRBD following urological surgery. The hypothesis of the study was that the TTNS intervention would be able to reduce the incidence to 30% \u003csup\u003e3,4,13\u003c/sup\u003e. With a 2-sided significance level of 0.05 and a power of 0.9, the total sample size was calculated to be 106 cases via PASS2021 software. Considering a 10% loss to follow-up rate, a total of 118 study subjects were needed, which were randomly assigned at a 1:1 ratio, with 59 study subjects assigned to each group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Statistical analysis\u003c/h2\u003e \u003cp\u003eData are expressed as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations, medians (lower quartiles, upper quartiles), and numbers (proportions), and relative risks (RRs) and 95% confidence intervals (95% CIs) were determined.\u003c/p\u003e \u003cp\u003eThe Shapiro‒Wilk test was used to assess whether continuous data conformed to a normal distribution. Independent t tests were used to test for normally distributed continuous variables. The Mann‒Whitney U test was used to compare nonnormally distributed continuous variables. The categorical variables were compared via the chi-square test or Fisher's exact test, and the relationships between ordered variables between two groups were analyzed via the Mann‒Whitney U test. If necessary, adjustments were made via the Bonferroni correction, and adjustments were considered significantly different at P\u0026thinsp;\u0026lt;\u0026thinsp;0.0125. In other cases, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, whereas P\u0026thinsp;\u0026lt;\u0026thinsp;0.001 was considered highly significant. The data were analyzed via the Statistical Package for the Social Sciences (SPSS, Version 27.0, IBM Corp, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 311 patients scheduled for urologic surgery were recruited for this study. Of these, 185 patients were excluded due to noncompliance with the inclusion and exclusion criteria, and 126 study subjects were randomly assigned. Following the grouping process, one patient was excluded because of a serious intraoperative cardiovascular event, and another was excluded because of postoperative refusal to participate in the trial. This resulted in a final sample of 62 patients in the TTNS group and 62 patients in the control group, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA comparative analysis of the clinical characteristics of patients in both groups revealed no significant disparities (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. These characteristics included age, BMI, ASA classification, underlying disease, duration of anesthesia, duration of surgery, surgical approach, postoperative analgesic pump utilization rate, and catheter size.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTTNS group (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.10\u0026thinsp;\u0026plusmn;\u0026thinsp;11.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.50\u0026thinsp;\u0026plusmn;\u0026thinsp;10.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.23(24.08,29.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.04(23.43,29.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA PS,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass Ⅰ/Ⅱ/Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (14.5%)/42 (67.7%)/11 (17.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (8.1%)/51 (82.3%)/6 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnesthesia time, minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (79.5\u0026thinsp;~\u0026thinsp;141)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.5 (77\u0026thinsp;~\u0026thinsp;122.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative time, minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87.5 (60\u0026thinsp;~\u0026thinsp;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81 (61.5\u0026thinsp;~\u0026thinsp;106.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative analgesia pump\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoley catheter diameter (Fr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;18/\u0026ge; 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(9.7%)/56(90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(12.9%)/54(87.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eData were expressed using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (lower quartile, upper quartile), and numbers (proportions). Control group, accepting connected circuits but no current as placebo; TTNS group, connect the circuit and give electrical stimulation for 30 min.\u003c/p\u003e \u003cp\u003eAbbreviation: BMI, Body Mass Index; ASA, American Society of Anesthesiologists.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, moderate to severe CRBD was observed at 0, 1, 2, and 6 h following tracheal extubation in both groups. TTNS stimulation resulted in a statistically significant reduction in the incidence of moderate to severe CRBD at 0 h after tracheal extubation compared with the control group [9 (14.50%) vs. 24 (38.7%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002, 95% CI = (0.190\u0026ndash;0.741), RR\u0026thinsp;=\u0026thinsp;0.375]. A comparison of the incidence of moderate to severe CRBD at 1 h after extubation [2 (3.2%) vs. 18 (29.0%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95% CI = (0.027\u0026ndash;0.459), RR\u0026thinsp;=\u0026thinsp;0.111] revealed a statistically significant decrease in the control group. Similarly, a decrease in the incidence of moderate to severe CRBD at 2 h after tracheal extubation was observed [1 (1.6%) vs. 11 (17.7%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002, 95% CI = (0.012\u0026ndash;0.683), RR\u0026thinsp;=\u0026thinsp;0.091]. However, a lack of statistically significant variation was identified in the occurrence of moderate or severe CRBD at 6 h following extubation between the two groups [2 (3.2%) vs. 4 (6.5%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.403, 95% CI = (0.095\u0026ndash;2.631), RR\u0026thinsp;=\u0026thinsp;0.5].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe CRBD grades at 0, 1, 2, and 6 h following tracheal extubation in the two groups are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A comparison of the two groups revealed that, in contrast to that in the control group, the severity of CRBD at 0, 1, 2, and 6 h following tracheal extubation was significantly lower in the TTNS group. This reduction was significant at 1, 2, and 6 hours (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe 0-, 1-, 2-, and 6-h VAS scores following tracheal extubation were meticulously documented (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A comparative analysis of VAS scores revealed a decrease in pain levels in the TTNS group relative to the control group at 0, 1, and 2 h following tracheal extubation, whereas no statistically significant differences were observed at 6 h: 0 h posttracheal extubation [2.05 (1.075\u0026thinsp;~\u0026thinsp;2.7) vs. 2.5 (1.7\u0026thinsp;~\u0026thinsp;2.8525), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009]; 1 h [2.5 (1.275\u0026thinsp;~\u0026thinsp;2.9) vs. 2.85 (1.725\u0026thinsp;~\u0026thinsp;3.425), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012]; 2 h [2.4 (1.15\u0026thinsp;~\u0026thinsp;2.7) vs. 3.0 (1.275\u0026thinsp;~\u0026thinsp;3.4), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013]; and 6 h [2.9 (1.375\u0026thinsp;~\u0026thinsp;3.3) vs. 3.2 (1.275\u0026thinsp;~\u0026thinsp;3.625), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.051].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative pain, postoperative medication, postoperative recovery and adverse effects in urologic surgical procedures are sufficient.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl group (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTTNS group (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 h after tracheal extubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.5 (1.7\u0026thinsp;~\u0026thinsp;2.8525)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.05 (1.075\u0026thinsp;~\u0026thinsp;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 h after tracheal extubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.85 (1.725\u0026thinsp;~\u0026thinsp;3.425)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5 (1.275\u0026thinsp;~\u0026thinsp;2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 h after tracheal extubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (1.275\u0026thinsp;~\u0026thinsp;3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.4 (1.15\u0026thinsp;~\u0026thinsp;2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 h after tracheal extubation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 (1.275\u0026thinsp;~\u0026thinsp;3.625)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9 (1.375\u0026thinsp;~\u0026thinsp;3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQoR-15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e128.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospital stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (7\u0026thinsp;~\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (6\u0026thinsp;~\u0026thinsp;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative dizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative nausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative agitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative delirium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication remediation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArrhythmias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllergies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eData were expressed using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median (lower quartile, upper quartile), and numbers (proportions). Control group, accepting connected circuits but no current as placebo; TTNS group, connect the circuit and give electrical stimulation for 30 min.\u003c/p\u003e \u003cp\u003eAbbreviation: VAS, visual analog scale; QoR-15, Quality of Recovery-15.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA comprehensive evaluation was conducted to assess postoperative recovery and other pertinent aspects of the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Compared with those in the control group, the patients in the TTNS group had significantly higher postoperative 24-hour QoR-15 scores (135.44\u0026thinsp;\u0026plusmn;\u0026thinsp;5.838 vs. 128.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.038, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the incidence of postoperative nausea [6 (9.7%) vs. 18 (29%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006] and medication remediation [17 (27.4%) vs. 36 (58.1%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001] in patients was significantly lower than that in the control group. A meticulous analysis revealed no statistically significant disparity in the duration of hospital stay between the two groups [9 (6\u0026thinsp;~\u0026thinsp;13) days vs. 10 (7\u0026thinsp;~\u0026thinsp;15) days, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.231]. The incidence of dizziness [2 (3.2% vs. 4 (6.5%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.403], vomiting [4 (6.5%) vs. 10 (16.1%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.089], and agitation [1 (1.6% vs. 5 (8.1%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.094] did not significantly differ between the two groups. Postoperative delirium or adverse events related to TTNS, such as arrhythmia, allergy, or skin discomfort at the electrode site, were not observed in any patient in either group.\u003c/p\u003e \u003cp\u003eA comparative analysis was conducted to ascertain the impact of the surgical approach on the incidence of moderate to severe CRBD following tracheal extubation (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The study revealed that in laparoscopic surgery, the observed difference in incidence between the TTNS group and the control group did not reach statistical significance [3 (12.5%) vs. 5 (20.8%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.439]. However, when the transurethral and percutaneous nephrolithotomy cohorts were analyzed, statistically significant differences were observed between the TTNS group and the control group: transurethral [3 (15.0%) vs. 9 (45.0%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038] and percutaneous nephrolithotomy [3 (16.7%) vs. 10 (55.6%), \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn our study, TTNS intervention was found to significantly reduce the incidence of moderate or severe CRBD at 0, 1, and 2 hours after tracheal extubation for urologic surgery, and it could change the grade of CRBD at 0, 1, 2, and 6 hours after tracheal extubation. In addition, the VAS scores of patients in the TTNS group were significantly lower than those in the control group at 0, 1, and 2 hours after tracheal extubation, and the postoperative 24-hour QoR-15 scores of patients in the TTNS group were significantly greater than those in the control group. We also found no adverse effects associated with the TTNS intervention.\u003c/p\u003e \u003cp\u003eTTNS is a technique that involves the modulation of the tibial nerve, which contains L4\u0026ndash;S3 nerve fibers from the same segment as the S2\u0026ndash;S4 nerve fibers that innervate the bladder\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Of particular relevance are the S3 nerve fibers, which contain sensory fibers from the pelvic floor and parasympathetic motor efferents to the detrusor muscle, as well as motor fibers from the pelvic sphincter and pelvic floor muscles. These motor fibers primarily innervate the detrusor and levator muscles. The use of TTNS in the treatment of lower urinary tract dysfunctions (LUTDs), such as OAB, has been well documented\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. A meta-analysis by Zifu Yu et al.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e evaluated the quality of evidence for the role of TTNS in improving maximal urethral pressure (MDP) in patients with neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI). Randomized controlled studies by Ya-Xiong Xu et al.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e and Argyrios Stampas et al.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Both studies reported that TTNS can be used to treat the clinical symptoms of OAB and has a favorable safety profile. Electrical stimulation of the afferent nerves of the posterior tibial nerve has been demonstrated to inhibit reflexive bladder activity. This inhibition occurs through the suppression of the upward pathway of the supraspinal pathway in the voiding reflex or the periaqueductal gray‒pontine micturition center (PMC) \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Additionally, electrical stimulation may directly inhibit the excitability of neurons in the sacral medullary pathway, thereby contributing to the inhibition of bladder activity\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The study by Todd Yecies et al.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e also reported that these neuromodulatory effects can occur while stimulation is ongoing and continue to be suppressed after 30 minutes of stimulation. The studies by Sibel Canbaz Kabay et al.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e and G Amarenco et al.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e found that tibial nerve stimulation improves acute urodynamics instantly and thus can be used to attenuate the onset of CRBD in the immediate postoperative period.\u003c/p\u003e \u003cp\u003eAccording to the gating doctrine, the application of high-frequency electrical stimulation initially activates myelinated A-β fibers. These fibers possess a lower threshold and exhibit faster conduction velocities. Additionally, stimulation triggers the premature activation of glial cells, resulting in the inhibition of conduction in class C fibers\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Brian Wodlinger et al. reported that high-frequency stimulation may also reduce nociceptive sensitization for analgesia by blocking C nerve fiber activity\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Research conducted by Jason P Paquette et al.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e and Zhonghan Zhou et al.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e These findings indicate that the activation of class C nerve fibers by low-frequency electrical stimulation can induce bladder inhibition. However, experiments by A Sato et al.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e and Michelle Yu et al.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Both studies reported that repeated application of high-frequency and low-frequency tibial nerve stimulation costimulated both to produce better inhibition and modulation of bladder function. Consequently, the alternating application of high- and low-frequency sparse wave stimulation of the tibial nerve may prove effective in the management of postoperative CRBD.\u003c/p\u003e \u003cp\u003eRecent studies have demonstrated that transcutaneous electrical nerve stimulation (TENS) facilitates the release of endogenous opioid peptides, reduces the level of inflammatory cytokines, and produces analgesia\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. The activation of \u0026micro;-opioid receptors is induced by low-frequency electrical stimulation, whereas the activation of δ-opioid receptors is induced by high-frequency stimulation\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Opioid medications, including tramadol and dizocine, have demonstrated clear efficacy in the treatment of CRBD\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. Consequently, the potential of TTNS to mitigate the severity of CRBD is a promising avenue for further research.\u003c/p\u003e \u003cp\u003eThe present study demonstrated that TTNS significantly reduced the severity of postoperative CRBD in patients who underwent urologic surgery. Notably, there was no statistically significant difference in the incidence of moderate-to-severe 6-hour CRBD between the TTNS group and the control group. However, a statistically significant difference was observed in the overall severity of CRBD. This phenomenon can be attributed to the observed reduction in mild CRBD, resulting in a relative increase in the proportion of patients with no CRBD. Consequently, TTNS has been shown to play a beneficial role in mitigating the severity of CRBD.\u003c/p\u003e \u003cp\u003eThe QoR-15 assessment revealed a substantial improvement in patient recovery quality following the TTNS intervention. The tibial nerve stimulation sites selected for this study (posterior to the medial ankle joint and approximately three transverse fingers above it) are located at the Chinese medicine acupuncture points belonging to the BL59 and BL60 in the bladder meridian of foot-taiyang. The stimulation of these two points in acupuncture treatment studies has been shown to shorten the awakening time of patients, improve postoperative analgesia, and contribute to the rapid recovery of patients after surgery\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The present study revealed that the TTNS group presented reduced postoperative VAS scores and a diminished prevalence of nausea. Moreover, the QoR-15 assessment demonstrated a substantial improvement in the quality of patient recovery following TTNS intervention. This phenomenon may be attributed to a reduction in the incidence of postoperative complications, which is a hallmark of enhanced recovery. This finding is pivotal for achieving a favorable prognosis, suggesting that a reduction in CRBD severity after TTNS intervention may provide substantial benefit.\u003c/p\u003e \u003cp\u003eA preponderance of extant research has demonstrated the infrequent occurrence of deleterious effects concomitant with TENS\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. The present study reports no adverse events that are unequivocally attributable to TENS. Consequently, 30 minutes of postoperative stimulation employing current sizes with pulses of 200 \u0026micro;s and alternating sparse-dense waves at a frequency of 20/100 hertz, which induce muscle contraction without pain, appears to be safe. However, the limited sample size of our trial precluded us from assessing the incidence of other serious events or generalizing to other intervention parameters.\u003c/p\u003e \u003cp\u003eThe efficacy and safety of TTNS intervention in reducing moderate to severe CRBD following transurethral or percutaneous nephrolithotomy have been demonstrated. However, the intervention did not have a significant effect on the postoperative period after laparoscopic surgery, likely due to the timing of the intervention, which could have been optimized. In this study, TTNS was initiated at the beginning of the postoperative period to improve acute urodynamics. However, because of its clinical use in the treatment of other bladder disorders, it is generally necessary to continue for several weeks, and the stimulation parameters have not been optimally selected\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Furthermore, the duration of intervention in studies of transcutaneous electrical stimulation of acupoints for CRBD varies\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Consequently, further trials are necessary to determine the optimal stimulation time and parameters. Additionally, a larger sample size is needed to determine the effectiveness of this protocol in preventing postoperative CRBD.\u003c/p\u003e \u003cp\u003eIt is imperative to acknowledge the limitations of this study. First, although the use of an alternating sparse-dense waves intervention with pulses of 200 \u0026micro;s and frequencies of 20/100 Hz resulted in moderate or greater reductions in CRBD, we cannot assert that this particular stimulation parameter is the optimal amount to prevent CRBD. Second, we performed TTNS at the conclusion of the procedure and were unable to ascertain whether this was the most effective time to prevent CRBD. Finally, the limited sample size of our trial precluded our ability to assess the incidence of other serious events. Consequently, further research is necessary to ascertain the most effective stimulation parameters and the optimal timing of TTNS intervention. Additionally, a larger sample size is needed to ascertain the efficacy of this regimen in preventing postoperative CRBD.\u003c/p\u003e \u003cp\u003eIn conclusion, patients receiving TTNS presented a reduced incidence of moderate or severe CRBD following urologic surgery. Furthermore, patients who received TTNS exhibited increased postoperative analgesia and improved postoperative recovery. These findings imply that the use of TTNS may be an effective strategy for mitigating postoperative CRBD in urologic surgery. Future studies should focus on expanding the sample size, improving the duration of intervention, and adjusting the stimulation parameters of TTNS to provide more comprehensive and reliable results.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eIn this study, we demonstrated that TTNS with pulses of 200 \u0026micro;s and alternating sparse-dense waves at a frequency of 20/100 Hz given for 30 min upon entering the recovery room can effectively reduce the occurrence of moderate-to-severe CRBD and its severity after general anesthesia in male patients with urology, strengthen the effect of postoperative analgesia, reduce the occurrence of postoperative nausea, and improve the quality of postoperative recovery. Moreover, it does not increase the occurrence of postoperative adverse events.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eCRBD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eCatheter-related bladder discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eTTNS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eTranscutaneous tibial nerve stimulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eOAB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eOveractive bladder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eAmerican Society of Anesthesiologists\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ePACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePostanesthesia care unit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eBlood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eHeart rate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSpO\u003csub\u003e2\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSaturation of peripheral oxygen\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eEGG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eElectrocardiogram\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eBIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eBispectral index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eTOF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eTrain of four\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003evisual analogue scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003ebody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eQoR-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eQuality of recovery-15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eLUTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eLower urinary tract dysfunctions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eMDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMaximal urethral pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eNLUTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eNeurogenic lower urinary tract dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSpinal cord injury\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003ePMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003ePeriaqueductal gray-pontine micturition center\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eTENS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003etranscutaneous electrical nerve stimulation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe present study was approved (approval number: KJ2023-437-01) by the Science and Technology Ethics Committee of the First Affiliated Hospital of Shihezi University, and written informed consent was obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available owing to the privacy of the patient data involved but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was conducted at the First Affiliated Hospital of Shihezi University and was supported by the Science and Technology Program of the Corps (NO. 2022ZD037, NO. 2022ZD077).\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eX.Z. helped in the conception and design of the work, acquired and analyzed the data, helped interpret the data, was a major contributor in writing the manuscript, revised the manuscript, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eY.L. helped in the conception and design of the work, acquired and analyzed the data, helped interpret the data, was a major contributor in writing the manuscript, and had final approval of this version.\u003c/p\u003e\n\u003cp\u003eT.W. was involved in the acquisition and analysis of the data, interpretation of the data, and final review of this version.\u003c/p\u003e\n\u003cp\u003eC.D. helped in the conception and design of the work, helped interpret the data, helped revise the article, and had final approval of this version.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChen, H. et al. Intravesical dexmedetomidine instillation reduces postoperative catheter-related bladder discomfort in male patients under general anesthesia: a randomized controlled study. BMC Anesthesiol 20, 267 (2020).\u003c/li\u003e\n\u003cli\u003eBai, Y. et al. Management of Catheter-Related Bladder Discomfort in Patients Who Underwent Elective Surgery. J Endourol 29, 640\u0026ndash;649 (2015).\u003c/li\u003e\n\u003cli\u003eLiang, D. et al. The Effect of Transcutaneous Electrical Acupoint Stimulation on Postoperative Catheter-Related Bladder Discomfort in Patients Undergoing Transurethral Resection of the Prostate. Evid Based Complement Alternat Med 2021, 6691459 (2021).\u003c/li\u003e\n\u003cli\u003ePark, J.-Y. et al. Vitamin C and catheter-related bladder discomfort after transurethral resection of bladder tumor: A double-blind, randomized, placebo-controlled study. Journal of Clinical Anesthesia 89, 111191 (2023).\u003c/li\u003e\n\u003cli\u003eLi, J. \u0026amp; Liao, R. Prevention of catheter-related bladder discomfort \u0026ndash; pudendal nerve block with ropivacaine versus intravenous tramadol: study protocol for a randomized controlled trial. Trials 17, 448 (2016).\u003c/li\u003e\n\u003cli\u003eBao, X. et al. The efficacy of peripheral nerve block on postoperative catheter-related bladder discomfort in males: A systematic review and meta-analysis. Front Surg 10, 1099628 (2023).\u003c/li\u003e\n\u003cli\u003eLi, S., Li, P., Wang, R. \u0026amp; Li, H. Different interventions for preventing postoperative catheter-related bladder discomfort: a systematic review and meta-analysis. Eur J Clin Pharmacol 78, 897\u0026ndash;906 (2022).\u003c/li\u003e\n\u003cli\u003eAgost-Gonz\u0026aacute;lez, A. et al. Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review. Healthcare (Basel) 9, 879 (2021).\u003c/li\u003e\n\u003cli\u003eKozma, B., Majoros, A., Pytel, \u0026Aacute;., P\u0026oacute;ka, R. \u0026amp; Tak\u0026aacute;cs, P. Efficacy of the percutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms. Orv Hetil 159, 1735\u0026ndash;1740 (2018).\u003c/li\u003e\n\u003cli\u003ePark, E. et al. The long-lasting post-stimulation inhibitory effects of bladder activity induced by posterior tibial nerve stimulation in unanesthetized rats. Sci Rep 10, 19897 (2020).\u003c/li\u003e\n\u003cli\u003eAl-Danakh, A. et al. Posterior Tibial Nerve Stimulation for Overactive Bladder: Mechanism, Classification, and Management Outlines. Parkinsons Dis 2022, 2700227 (2022).\u003c/li\u003e\n\u003cli\u003eAbello, A. \u0026amp; Das, A. K. Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects. Ther Adv Urol 10, 165\u0026ndash;173 (2018).\u003c/li\u003e\n\u003cli\u003eAgarwal, A. et al. An Evaluation of the Efficacy of Gabapentin for Prevention of Catheter-Related Bladder Discomfort: A Prospective, Randomized, Placebo-Controlled, Double-Blind Study. Anesthesia \u0026amp; Analgesia 105, 1454\u0026ndash;1457 (2007).\u003c/li\u003e\n\u003cli\u003eLi, X., Li, X. \u0026amp; Liao, L. Mechanism of Action of Tibial Nerve Stimulation in the Treatment of Lower Urinary Tract Dysfunction. Neuromodulation: Technology at the Neural Interface 27, 256\u0026ndash;266 (2024).\u003c/li\u003e\n\u003cli\u003eLightner, D. J., Gomelsky, A., Souter, L. \u0026amp; Vasavada, S. P. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. The Journal of Urology (2019) doi:10.1097/JU.0000000000000309.\u003c/li\u003e\n\u003cli\u003eYu, Z. et al. Effects of non-invasive or minimally invasive neuromodulation techniques on neurogenic lower urinary tract dysfunction after spinal cord injury: A network meta-analysis. Arch Phys Med Rehabil S0003-9993(24)01420\u0026ndash;5 (2024) doi:10.1016/j.apmr.2024.12.016.\u003c/li\u003e\n\u003cli\u003eXu, Y.-X. et al. Efficacy of the combination of transcutaneous tibial nerve stimulation and mirabegron in women with overactive bladder in a prospective randomized controlled trial. Sci Rep 14, 27248 (2024).\u003c/li\u003e\n\u003cli\u003eStampas, A., Korupolu, R., Lee, K. H., Salazar, B. \u0026amp; Khavari, R. Reduction of Overactive Bladder Medications in Spinal Cord Injury With Self-Administered Neuromodulation: A Randomized Trial. J Urol 212, 800\u0026ndash;810 (2024).\u003c/li\u003e\n\u003cli\u003eLyon, T. D. et al. Pudendal but not tibial nerve stimulation inhibits bladder contractions induced by stimulation of pontine micturition center in cats. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 310, R366\u0026ndash;R374 (2016).\u003c/li\u003e\n\u003cli\u003eXiao, Z. et al. Somatic modulation of spinal reflex bladder activity mediated by nociceptive bladder afferent nerve fibers in cats. Am J Physiol Renal Physiol 307, 673\u0026ndash;679 (2014).\u003c/li\u003e\n\u003cli\u003eGupta, P., Ehlert, M. J., Sirls, L. T. \u0026amp; Peters, K. M. Percutaneous Tibial Nerve Stimulation and Sacral Neuromodulation: an Update. Curr Urol Rep 16, 4 (2015).\u003c/li\u003e\n\u003cli\u003eYecies, T. et al. Spinal interneuronal mechanisms underlying pudendal and tibial neuromodulation of bladder function in cats. Exp Neurol 308, 100\u0026ndash;110 (2018).\u003c/li\u003e\n\u003cli\u003eKabay, S. C., Kabay, S., Yucel, M. \u0026amp; Ozden, H. Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson\u0026rsquo;s disease. Neurourol Urodyn 28, 62\u0026ndash;67 (2009).\u003c/li\u003e\n\u003cli\u003eAmarenco, G. et al. Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder. J Urol 169, 2210\u0026ndash;2215 (2003).\u003c/li\u003e\n\u003cli\u003eMendell, L. M. Constructing and deconstructing the gate theory of pain. Pain 155, 210\u0026ndash;216 (2014).\u003c/li\u003e\n\u003cli\u003eWodlinger, B., Rashid, S. \u0026amp; Durand, D. M. Block of peripheral pain response by high-frequency sinusoidal stimulation. Neuromodulation 16, 312\u0026ndash;317 (2013).\u003c/li\u003e\n\u003cli\u003ePaquette, J. P. \u0026amp; Yoo, P. B. Recruitment of unmyelinated C-fibers mediates the bladder-inhibitory effects of tibial nerve stimulation in a continuous-fill anesthetized rat model. Am J Physiol Renal Physiol 317, 163\u0026ndash;171 (2019).\u003c/li\u003e\n\u003cli\u003eZhou, Z., Wang, X., Li, X. \u0026amp; Liao, L. Transdermal tibial nerve optogenetic stimulation targeting C-fibers. Front Physiol 14, 1224088 (2023).\u003c/li\u003e\n\u003cli\u003eSato, A., Sato, Y. \u0026amp; Schmidt, R. F. Reflex bladder activity induced by electrical stimulation of hind limb somatic afferents in the cat. J Auton Nerv Syst 1, 229\u0026ndash;241 (1980).\u003c/li\u003e\n\u003cli\u003eYu, M. et al. An excitatory reflex from the superficial peroneal nerve to the bladder in cats. Am J Physiol Renal Physiol 313, 1161\u0026ndash;1168 (2017).\u003c/li\u003e\n\u003cli\u003edo Carmo Almeida, T. C. et al. Effects of Transcutaneous Electrical Nerve Stimulation on Proinflammatory Cytokines: Systematic Review and Meta-Analysis. Mediators Inflamm 2018, 1094352 (2018).\u003c/li\u003e\n\u003cli\u003eUlloa, L., Quiroz-Gonzalez, S. \u0026amp; Torres-Rosas, R. Nerve Stimulation: Immunomodulation and Control of Inflammation. Trends Mol Med 23, 1103\u0026ndash;1120 (2017).\u003c/li\u003e\n\u003cli\u003eVance, C. G. T., Dailey, D. L., Rakel, B. A. \u0026amp; Sluka, K. A. Using TENS for pain control: the state of the evidence. Pain Manag 4, 197\u0026ndash;209 (2014).\u003c/li\u003e\n\u003cli\u003eSluka, K. A., Bjordal, J. M., Marchand, S. \u0026amp; Rakel, B. A. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther 93, 1397\u0026ndash;1402 (2013).\u003c/li\u003e\n\u003cli\u003eAgarwal, A., Yadav, G., Gupta, D., Singh, P. K. \u0026amp; Singh, U. Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study. Br J Anaesth 101, 506\u0026ndash;510 (2008).\u003c/li\u003e\n\u003cli\u003eZhang, G.-F. et al. Effects of dezocine for the prevention of postoperative catheter-related bladder discomfort: a prospective randomized trial. Drug Des Devel Ther 13, 1281\u0026ndash;1288 (2019).\u003c/li\u003e\n\u003cli\u003eYANG, Y. et al. Effects of transcutaneous electrical acupoint stimulation on recovery of patients undergoing robotic gynecologic surgery. J Clin Anesthesiol 34, 11\u0026ndash;15 (2018).\u003c/li\u003e\n\u003cli\u003eChen, Y. et al. The effectiveness and safety of oral medications, onabotulinumtoxinA (three doses) and transcutaneous tibial nerve stimulation as non or minimally invasive treatment for the management of neurogenic detrusor overactivity in adults: a systematic review and network meta-analysis. Int J Surg 109, 1430\u0026ndash;1438 (2023).\u003c/li\u003e\n\u003cli\u003eZhang, Y. et al. Effect of Transcutaneous Acupoint Electrical Stimulation on Urinary Retention and Urinary ATP in Elderly Patients After Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled Clinical Trial. Clin Interv Aging 17, 1751\u0026ndash;1760 (2022).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"catheter-related bladder discomfort, transcutaneous tibial nerve stimulation, urology, general anesthesia, male","lastPublishedDoi":"10.21203/rs.3.rs-6259020/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6259020/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMale patients who undergo general anesthesia for urologic surgery are more prone to developing catheter-related bladder discomfort (CRBD). Transcutaneous tibial nerve stimulation (TTNS) is an established intervention for lower urinary tract dysfunction. This study aimed to evaluate the impact of TTNS on the occurrence of moderate to severe CRBD in male patients undergoing urological general anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The present study included 124 male urologic surgery patients from December 2023--June 2024 and were randomly divided into a test group and a control group via stratified block group randomization. The test group received 30 minutes of TTNS stimulation (200-μs pulses, 20/100 Hz alternating sparse-dense waves) in the recovery room after surgery, and the control group received 30 minutes of sham stimulation. The degree of CRBD and VAS scores at 0 h, 1 h, 2 h, and 6 h after tracheal extubation, the QoR-15 scores at 24 h postoperatively, the length of hospitalization, the medication remedy rates, and the occurrence of adverse reactions were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Compared with the control group, the present study demonstrated a statistically significant reduction in the incidence of moderate-to-severe CRBD at 0 hours after tracheal extubation in the TTNS group [\u003cem\u003eP\u003c/em\u003e = 0.002, CI=0.190–0.741, RR = 0.375]. The incidence of moderate to severe CRBD in the TTNS group was significantly lower than that in the C group at 1 and 2 hours after extubation (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001, \u003cem\u003eP\u003c/em\u003e = 0.002). Furthermore, the severity of CRBD at 0, 1, 2, and 6 hours after extubation was significantly different from that in the TTNS group (\u003cem\u003eP \u003c/em\u003e= 0.017, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, and \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001, respectively). The VAS scores of patients in the TTNS group were notably lower than those in the C group at 0, 1, and 2 hours after tracheal extubation (\u003cem\u003eP\u003c/em\u003e = 0.009, \u003cem\u003eP\u003c/em\u003e = 0.012, \u003cem\u003eP\u003c/em\u003e = 0.013, \u003cem\u003eP\u003c/em\u003e= 0.051, respectively). Compared with those in the C group, the QoR-15 scores at 24 hours postsurgery in the TTNS group were markedly greater (\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.001). The incidence of postoperative nausea and medication rescue was lower in the TTNS group than in the C group (\u003cem\u003eP\u003c/em\u003e = 0.006, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). The TTNS intervention was not associated with any adverse effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e TTNS effectively reduces moderate-to-severe CRBD incidence, enhances early postoperative analgesia, and improves recovery quality in male urologic surgery patients without significant safety concerns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003eThis study was retrospectively registered and reviewed by a principal investigator (Xiangying Zheng) in the Chinese Clinical Trials Registry (registration number: ChiCTR2300078536) on 12/12/2023.\u003c/p\u003e","manuscriptTitle":"Influence of Transcutaneous Tibial Nerve Stimulation on Postoperative Catheter-Related Bladder Discomfort in Urology: A Prospective, Randomized, Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-05 05:44:27","doi":"10.21203/rs.3.rs-6259020/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-19T05:03:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T14:39:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192099363186688808814508147009123440733","date":"2025-05-25T13:49:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-05T16:37:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87283629777079587058621132065550313034","date":"2025-05-01T09:25:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-03T22:56:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-03T22:44:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-03T14:34:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-03T07:15:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-19T07:27:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2662efed-762a-4b70-bb4e-51ceb0b101c6","owner":[],"postedDate":"May 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47494589,"name":"Health sciences/Medical research/Study design/Randomized controlled trials"},{"id":47494590,"name":"Health sciences/Urology/Urogenital diseases/Bladder disease"}],"tags":[],"updatedAt":"2025-12-22T15:58:50+00:00","versionOfRecord":{"articleIdentity":"rs-6259020","link":"https://doi.org/10.1038/s41598-025-32254-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-12-15 15:56:50","publishedOnDateReadable":"December 15th, 2025"},"versionCreatedAt":"2025-05-05 05:44:27","video":"","vorDoi":"10.1038/s41598-025-32254-w","vorDoiUrl":"https://doi.org/10.1038/s41598-025-32254-w","workflowStages":[]},"version":"v1","identity":"rs-6259020","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6259020","identity":"rs-6259020","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}