Review Articles|Articles in Press

Mechanism of Action of Tibial Nerve Stimulation in the Treatment of Lower Urinary Tract Dysfunction

  • Xunhua Li
    School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China

    University of Health and Rehabilitation Sciences, Qingdao, China
    Search for articles by this author
  • Xing Li
    School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China
    Search for articles by this author
  • Limin Liao
    Address correspondence to: Limin Liao, MD, PhD, Department of Urology, China Rehabilitation Research Center, China Rehabilitation Science Institute, Beijing 10000, China.
    School of Rehabilitation, Capital Medical University, Department of Urology, China Rehabilitation Research Center, Beijing, China

    University of Health and Rehabilitation Sciences, Qingdao, China

    China Rehabilitation Science Institute, Beijing, China
    Search for articles by this author


      Background and Objective

      Tibial nerve stimulation (TNS) has long been used to effectively treat lower urinary tract dysfunction (LUTD). Although numerous studies have concentrated on TNS, its mechanism of action remains elusive. This review aimed to concentrate on the mechanism of action of TNS against LUTD.

      Materials and Methods

      A literature search was performed in PubMed on October 31, 2022. In this study, we introduced the application of TNS for LUTD, summarized different methods used in exploring the mechanism of TNS, and discussed the next direction to investigate the mechanism of TNS.

      Results and Conclusions

      In this review, 97 studies, including clinical studies, animal experiments, and reviews, were used. TNS is an effective treatment for LUTD. The study of its mechanisms primarily concentrated on the central nervous system, tibial nerve pathway, receptors, and TNS frequency. More advanced equipment will be used in human experiments to investigate the central mechanism, and diverse animal experiments will be performed to explore the peripheral mechanism and parameters of TNS in the future.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Panicker J.N.
        • Fowler C.J.
        • Kessler T.M.
        Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.
        Lancet Neurol. 2015; 14: 720-732
        • Haylen B.T.
        • de Ridder D.
        • Freeman R.M.
        • et al.
        An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction.
        Neurourol Urodyn. 2010; 29: 4-20
        • Abello A.
        • Das A.K.
        Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects.
        Ther Adv Urol. 2018; 10: 165-173
        • Irwin D.E.
        • Milsom I.
        • Hunskaar S.
        • et al.
        Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study.
        Eur Urol. 2006; 50 ([discussion: 14–15]): 1306-1314
        • Irwin D.E.
        • Kopp Z.S.
        • Agatep B.
        • Milsom I.
        • Abrams P.
        Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction.
        BJU Int. 2011; 108: 1132-1138
        • Raju R.
        • Linder B.J.
        Evaluation and treatment of overactive bladder in women.
        Mayo Clin Proc. 2020; 95: 370-377
        • Stoller M.L.
        Afferent nerve stimulation for pelvic floor dysfunction.
        Eur Urol. 2000; 37: 33-37
        • Gaziev G.
        • Topazio L.
        • Iacovelli V.
        • et al.
        Percutaneous Tibial Nerve Stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions: a systematic review.
        BMC Urol. 2013; 13: 61
        • Te Dorsthorst M.
        • van Balken M.
        • Heesakkers J.
        Tibial nerve stimulation in the treatment of overactive bladder syndrome: technical features of latest applications.
        Curr Opin Urol. 2020; 30: 513-518
        • Al-Danakh A.
        • Safi M.
        • Alradhi M.
        • et al.
        Posterior tibial nerve stimulation for overactive bladder: mechanism, classification, and management outlines.
        Parkinsons Dis. 2022; 20222700227
        • Tutolo M.
        • Ammirati E.
        • Van der Aa F.
        What is new in neuromodulation for overactive bladder?.
        Eur Urol Focus. 2018; 4: 49-53
        • Coolen R.L.
        • Groen J.
        • Scheepe J.R.
        • Blok B.F.M.
        Transcutaneous electrical nerve stimulation and percutaneous tibial nerve stimulation to treat idiopathic nonobstructive urinary retention: a systematic review.
        Eur Urol Focus. 2021; 7: 1184-1194
        • Sudol N.T.
        • Guaderrama N.
        • Adams-Piper E.
        • Whitcomb E.
        • Lane F.
        Percutaneous tibial nerve stimulation for the treatment of interstitial cystitis/bladder pain syndrome: a pilot study.
        Int Urogynecol J. 2021; 32: 2757-2764
        • Fowler C.J.
        • Griffiths D.
        • de Groat W.C.
        The neural control of micturition.
        Nat Rev Neurosci. 2008; 9: 453-466
        • de Groat W.C.
        • Griffiths D.
        • Yoshimura N.
        Neural control of the lower urinary tract.
        Compr Physiol. 2015; 5: 327-396
        • Arya N.G.
        • Weissbart S.J.
        Central control of micturition in women: brain-bladder pathways in continence and urgency urinary incontinence.
        Clin Anat. 2017; 30: 373-384
        • Weledji E.P.
        • Eyongeta D.
        • Ngounou E.
        The anatomy of urination: what every physician should know.
        Clin Anat. 2019; 32: 60-67
        • Blok B.F.
        • Sturms L.M.
        • Holstege G.
        A PET study on cortical and subcortical control of pelvic floor musculature in women.
        J Comp Neurol. 1997; 389: 535-544
        • Leach G.E.
        • Farsaii A.
        • Kark P.
        • Raz S.
        Urodynamic manifestations of cerebellar ataxia.
        J Urol. 1982; 128: 348-350
        • Athwal B.S.
        • Berkley K.J.
        • Hussain I.
        • et al.
        Brain responses to changes in bladder volume and urge to void in healthy men.
        Brain. 2001; 124: 369-377
        • Matsuura S.
        • Kakizaki H.
        • Mitsui T.
        • Shiga T.
        • Tamaki N.
        • Koyanagi T.
        Human brain region response to distention or cold stimulation of the bladder: a positron emission tomography study.
        J Urol. 2002; 168: 2035-2039
        • Cruccu G.
        • Aminoff M.J.
        • Curio G.
        • et al.
        Recommendations for the clinical use of somatosensory-evoked potentials.
        Clin Neurophysiol. 2008; 119: 1705-1719
        • Sarica Y.
        • Karacan I.
        • Thornby J.I.
        • Hirshkowitz M.
        Cerebral responses evoked by stimulation of vesico-urethral junction in man: methodological evaluation of monopolar stimulation.
        Electroencephalogr Clin Neurophysiol. 1986; 65: 130-135
        • Deltenre P.F.
        • Thiry A.J.
        Urinary bladder cortical evoked potentials in man: suitable stimulation techniques.
        Br J Urol. 1989; 64: 381-384
        • Hansen M.V.
        • Ertekin C.
        • Larsson L.E.
        • Pedersen K.
        A neurophysiological study of patients undergoing radical prostatectomy.
        Scand J Urol Nephrol. 1989; 23: 267-273
        • Berić A.
        • Prevec T.S.
        Distribution of scalp somatosensory potentials evoked by stimulation of the tibial nerve in man.
        J Neurol Sci. 1983; 59: 205-214
        • Takahashi H.
        • Suzuki I.
        • Ishijima B.
        Cortical and subcortical SEPs following posterior tibial nerve stimulation.
        Brain Topogr. 1996; 8: 233-235
        • Hauck M.
        • Baumgärtner U.
        • Hille E.
        • Hille S.
        • Lorenz J.
        • Quante M.
        Evidence for early activation of primary motor cortex and SMA after electrical lower limb stimulation using EEG source reconstruction.
        Brain Res. 2006; 1125: 17-25
        • Finazzi-Agrò E.
        • Rocchi C.
        • Pachatz C.
        • et al.
        Percutaneous tibial nerve stimulation produces effects on brain activity: study on the modifications of the long latency somatosensory evoked potentials.
        Neurourol Urodyn. 2009; 28: 320-324
        • Hämäläinen M.
        • Hari R.
        • Ilmoniemi R.J.
        • Knuutila J.
        • Lounasmaa O.V.
        Magnetoencephalography—theory, instrumentation, and applications to noninvasive studies of the working human brain.
        Rev Mod Phys. 1993; 65: 413-497
        • Hari R.
        • Reinikainen K.
        • Kaukoranta E.
        • et al.
        Somatosensory evoked cerebral magnetic fields from SI and SII in man.
        Electroencephalogr Clin Neurophysiol. 1984; 57: 254-263
        • Huttunen J.
        • Kaukoranta E.
        • Hari R.
        Cerebral magnetic responses to stimulation of tibial and sural nerves.
        J Neurol Sci. 1987; 79: 43-54
        • Narici L.
        • Modena I.
        • Opsomer R.J.
        • et al.
        Neuromagnetic somatosensory homunculus: a non-invasive approach in humans.
        Neurosci Lett. 1991; 121: 51-54
        • Hari R.
        • Nagamine T.
        • Nishitani N.
        • et al.
        Time-varying activation of different cytoarchitectonic areas of the human SI cortex after tibial nerve stimulation.
        Neuroimage. 1996; 4: 111-118
        • Kakigi R.
        • Koyama S.
        • Hoshiyama M.
        • Shimojo M.
        • Kitamura Y.
        • Watanabe S.
        Topography of somatosensory evoked magnetic fields following posterior tibial nerve stimulation.
        Electroencephalogr Clin Neurophysiol. 1995; 95: 127-134
        • Shimojo M.
        • Kakigi R.
        • Hoshiyama M.
        • Koyama S.
        • Watanabe S.
        Magnetoencephalographic study of intracerebral interactions caused by bilateral posterior tibial nerve stimulation in man.
        Neurosci Res. 1997; 28: 41-47
        • Lynch J.C.
        The functional organization of posterior parietal association cortex.
        Behav Brain Sci. 1980; 3: 485-499
        • Hoshiyama M.
        • Kakigi R.
        • Koyama S.
        • Watanabe S.
        • Shimojo M.
        Activity in posterior parietal cortex following somatosensory stimulation in man: magnetoencephalographic study using spatio-temporal source analysis.
        Brain Topogr. 1997; 10: 23-30
        • Kwong K.K.
        Functional magnetic resonance imaging with echo planar imaging.
        Magn Reson Q. 1995; 11: 1-20
        • Del Gratta C.
        • Della Penna S.
        • Ferretti A.
        • et al.
        Topographic organization of the human primary and secondary somatosensory cortices: comparison of fMRI and MEG findings.
        Neuroimage. 2002; 17: 1373-1383
        • Del Gratta C.
        • Della Penna S.
        • Tartaro A.
        • et al.
        Topographic organization of the human primary and secondary somatosensory areas: an fMRI study.
        NeuroReport. 2000; 11: 2035-2043
        • Arienzo D.
        • Babiloni C.
        • Ferretti A.
        • et al.
        Somatotopy of anterior cingulate cortex (ACC) and supplementary motor area (SMA) for electric stimulation of the median and tibial nerves: an fMRI study.
        Neuroimage. 2006; 33: 700-705
        • Xiao Z.
        • Rogers M.J.
        • Shen B.
        • et al.
        Somatic modulation of spinal reflex bladder activity mediated by nociceptive bladder afferent nerve fibers in cats.
        Am J Physiol Renal Physiol. 2014; 307: F673-F679
        • Ferroni M.C.
        • Slater R.C.
        • Shen B.
        • et al.
        Role of the brain stem in tibial inhibition of the micturition reflex in cats.
        Am J Physiol Renal Physiol. 2015; 309: F242-F250
        • Lyon T.D.
        • Ferroni M.C.
        • Kadow B.T.
        • et al.
        Pudendal but not tibial nerve stimulation inhibits bladder contractions induced by stimulation of pontine micturition center in cats.
        Am J Physiol Regul Integr Comp Physiol. 2016; 310: R366-R374
        • Bansal U.
        • Fuller T.W.
        • Jiang X.
        • et al.
        Lumbosacral spinal segmental contributions to tibial and pudendal neuromodulation of bladder overactivity in cats.
        Neurourol Urodyn. 2017; 36: 1496-1502
        • Morgan C.
        • Nadelhaft I.
        • de Groat W.C.
        The distribution of visceral primary afferents from the pelvic nerve to Lissauer’s tract and the spinal gray matter and its relationship to the sacral parasympathetic nucleus.
        J Comp Neurol. 1981; 201: 415-440
        • Yecies T.
        • Li S.
        • Zhang Y.
        • et al.
        Spinal interneuronal mechanisms underlying pudendal and tibial neuromodulation of bladder function in cats.
        Exp Neurol. 2018; 308: 100-110
        • Tai C.
        • Chen M.
        • Shen B.
        • Wang J.
        • Roppolo J.R.
        • de Groat W.C.
        Irritation induced bladder overactivity is suppressed by tibial nerve stimulation in cats.
        J Urol. 2011; 186: 326-330
        • Tai C.
        • Shen B.
        • Chen M.
        • Wang J.
        • Roppolo J.R.
        • de Groat W.C.
        Prolonged poststimulation inhibition of bladder activity induced by tibial nerve stimulation in cats.
        Am J Physiol Renal Physiol. 2011; 300: F385-F392
        • 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. 1980; 1: 229-241
        • 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. 2019; 317: F163-F171
        • Stein C.
        Opioid receptors.
        Annu Rev Med. 2016; 67: 433-451
        • Roppolo J.R.
        • Booth A.M.
        • De Groat W.C.
        The effects of naloxone on the neural control of the urinary bladder of the cat.
        Brain Res. 1983; 264: 355-358
        • Hisamitsu T.
        • de Groat W.C.
        The inhibitory effect of opioid peptides and morphine applied intrathecally and intracerebroventricularly on the micturition reflex in the cat.
        Brain Res. 1984; 298: 51-65
        • Tai C.
        • Larson J.A.
        • Ogagan P.D.
        • et al.
        Differential role of opioid receptors in tibial nerve inhibition of nociceptive and nonnociceptive bladder reflexes in cats.
        Am J Physiol Renal Physiol. 2012; 302: F1090-F1097
        • Zhang F.
        • Mally A.D.
        • Ogagan P.D.
        • et al.
        Inhibition of bladder overactivity by a combination of tibial neuromodulation and tramadol treatment in cats.
        Am J Physiol Renal Physiol. 2012; 302: F1576-F1582
        • Rogers M.J.
        • Xiao Z.
        • Shen B.
        • et al.
        Propranolol, but not naloxone, enhances spinal reflex bladder activity and reduces pudendal inhibition in cats.
        Am J Physiol Regul Integr Comp Physiol. 2015; 308: R42-R49
        • Zhang Z.
        • Slater R.C.
        • Ferroni M.C.
        • et al.
        Role of micro, kappa, and delta opioid receptors in tibial inhibition of bladder overactivity in cats.
        J Pharmacol Exp Ther. 2015; 355: 228-234
        • Yoon M.H.
        • Choi Jl
        • Bae H.B.
        • et al.
        Antinociceptive effects and synergistic interaction with morphine of intrathecal metabotropic glutamate receptor 2/3 antagonist in the formalin test of rats.
        Neurosci Lett. 2006; 394: 222-226
        • Fischer B.D.
        • Miller L.L.
        • Henry F.E.
        • Picker M.J.
        • Dykstra L.A.
        Increased efficacy of micro-opioid agonist-induced antinociception by metabotropic glutamate receptor antagonists in C57BL/6 mice: comparison with (-)-6-phosphonomethyl-deca-hydroisoquinoline-3-carboxylic acid (LY235959).
        Psychopharmacol (Berl). 2008; 198: 271-278
        • Fischer B.D.
        • Zimmerman E.I.
        • Picker M.J.
        • Dykstra L.A.
        Morphine in combination with metabotropic glutamate receptor antagonists on schedule-controlled responding and thermal nociception.
        J Pharmacol Exp Ther. 2008; 324: 732-739
        • Osikowicz M.
        • Mika J.
        • Makuch W.
        • Przewlocka B.
        Glutamate receptor ligands attenuate allodynia and hyperalgesia and potentiate morphine effects in a mouse model of neuropathic pain.
        Pain. 2008; 139: 117-126
        • Matsuta Y.
        • Mally A.D.
        • Zhang F.
        • et al.
        Contribution of opioid and metabotropic glutamate receptor mechanisms to inhibition of bladder overactivity by tibial nerve stimulation.
        Am J Physiol Regul Integr Comp Physiol. 2013; 305: R126-R133
        • Bowery N.G.
        • Bettler B.
        • Froestl W.
        • et al.
        International Union of Pharmacology. XXXIII. Mammalian gamma-aminobutyric acid(B) receptors: structure and function.
        Pharmacol Rev. 2002; 54: 247-264
        • Andersson K.E.
        • Pehrson R.
        CNS involvement in overactive bladder: pathophysiology and opportunities for pharmacological intervention.
        Drugs. 2003; 63: 2595-2611
        • Otis T.S.
        • De Koninck Y.
        • Mody I.
        Characterization of synaptically elicited GABAB responses using patch-clamp recordings in rat hippocampal slices.
        J Physiol. 1993; 463: 391-407
        • Soltesz I.
        • Mody I.
        Patch-clamp recordings reveal powerful GABAergic inhibition in dentate hilar neurons.
        J Neurosci. 1994; 14: 2365-2376
        • Sieghart W.
        Structure, pharmacology, and function of GABAA receptor subtypes.
        Adv Pharmacol. 2006; 54: 231-263
        • Xiao Z.
        • Reese J.
        • Schwen Z.
        • et al.
        Role of spinal GABAA receptors in pudendal inhibition of nociceptive and nonnociceptive bladder reflexes in cats.
        Am J Physiol Renal Physiol. 2014; 306: F781-F789
        • Fuller T.W.
        • Jiang X.
        • Bansal U.
        • et al.
        Sex difference in the contribution of GABA(B) receptors to tibial neuromodulation of bladder overactivity in cats.
        Am J Physiol Regul Integr Comp Physiol. 2017; 312: R292-R300
        • Pertwee R.G.
        • Ross R.A.
        Cannabinoid receptors and their ligands.
        Prostaglandins Leukot Essent Fatty Acids. 2002; 66: 101-121
        • Ruggieri M.R.
        Sr. Cannabinoids: potential targets for bladder dysfunction.
        Handb Exp Pharmacol. 2011; 202: 425-451
        • Andersson K.E.
        Potential future pharmacological treatment of bladder dysfunction.
        Basic Clin Pharmacol Toxicol. 2016; 119: 75-85
        • Füllhase C.
        • Schreiber A.
        • Giese A.
        • et al.
        Spinal neuronal cannabinoid receptors mediate urodynamic effects of systemic fatty acid amide hydrolase (FAAH) inhibition in rats.
        Neurourol Urodyn. 2016; 35: 464-470
        • Hedlund P.
        • Gratzke C.
        The endocannabinoid system - a target for the treatment of LUTS?.
        Nat Rev Urol. 2016; 13: 463-470
        • Fattore L.
        • Deiana S.
        • Spano S.M.
        • et al.
        Endocannabinoid system and opioid addiction: behavioural aspects.
        Pharmacol Biochem Behav. 2005; 81: 343-359
        • Viganò D.
        • Rubino T.
        • Parolaro D.
        Molecular and cellular basis of cannabinoid and opioid interactions.
        Pharmacol Biochem Behav. 2005; 81: 360-368
        • Jiang X.
        • Yu M.
        • Uy J.
        • et al.
        Role of cannabinoid receptor type 1 in tibial and pudendal neuromodulation of bladder overactivity in cats.
        Am J Physiol Ren Physiol. 2017; 312: F482-F488
        • Peters K.M.
        • Macdiarmid S.A.
        • Wooldridge L.S.
        • et al.
        Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial.
        J Urol. 2009; 182: 1055-1061
        • Peters K.M.
        • Carrico D.J.
        • Perez-Marrero R.A.
        • et al.
        Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial.
        J Urol. 2010; 183: 1438-1443
        • Li S.
        • Browning J.
        • Theisen K.
        • et al.
        Prolonged nonobstructive urinary retention induced by tibial nerve stimulation in cats.
        Am J Physiol Regul Integr Comp Physiol. 2020; 318: R428-R434
        • Moazzam Z.
        • Duke A.R.
        • Yoo P.B.
        Inhibition and excitation of bladder function by tibial nerve stimulation using a wirelessly powered implant: an acute study in anesthetized cats.
        J Urol. 2016; 196: 926-933
        • Su X.
        • Nickles A.
        • Nelson D.E.
        Comparison of neural targets for neuromodulation of bladder micturition reflex in the rat.
        Am J Physiol Renal Physiol. 2012; 303: F1196-F1206
        • Kovacevic M.
        • Yoo P.B.
        Reflex neuromodulation of bladder function elicited by posterior tibial nerve stimulation in anesthetized rats.
        Am J Physiol Renal Physiol. 2015; 308: F320-F329
        • Choudhary M.
        • van Mastrigt R.
        • van Asselt E.
        Effect of tibial nerve stimulation on bladder afferent nerve activity in a rat detrusor overactivity model.
        Int J Urol. 2016; 23: 253-258
        • Choudhary M.
        • van Mastrigt R.
        • van Asselt E.
        The frequency spectrum of bladder non-voiding activity as a trigger-event for conditional stimulation: closed-loop inhibition of bladder contractions in rats.
        Neurourol Urodyn. 2018; 37: 1567-1573
        • Wang M.
        • Jian Z.
        • Ma Y.
        • Jin X.
        • Li H.
        • Wang K.
        Percutaneous tibial nerve stimulation for overactive bladder syndrome: a systematic review and meta-analysis.
        Int Urogynecol J. 2020; 31: 2457-2471
        • Park E.
        • Lee J.W.
        • Kim T.
        • et al.
        The long-lasting post-stimulation inhibitory effects of bladder activity induced by posterior tibial nerve stimulation in unanesthetized rats.
        Sci Rep. 2020; 1019897
        • Theisen K.
        • Browning J.
        • Li X.
        • et al.
        Frequency dependent tibial neuromodulation of bladder underactivity and overactivity in cats.
        Neuromodulation. 2018; 21: 700-706
        • Kamboonlert K.
        • Panyasriwanit S.
        • Tantisiriwat N.
        • Kitisomprayoonkul W.
        Effects of bilateral transcutaneous tibial nerve stimulation on neurogenic detrusor overactivity in spinal cord injury: a urodynamic study.
        Arch Phys Med Rehabil. 2021; 102: 1165-1169
        • Girtner F.
        • Fritsche H.M.
        • Zeman F.
        • et al.
        Randomized crossover-controlled evaluation of simultaneous bilateral transcutaneous electrostimulation of the posterior tibial nerve during urodynamic studies in patients with lower urinary tract symptoms.
        Int Neurourol J. 2021; 25: 337-346
        • Uzuka Y.
        • Hiramatsu I.
        • Onishi T.
        • Nagata T.
        Effect of simultaneous bilateral tibial nerve stimulation on somatosensory evoked potentials (SEP) in dogs.
        J Vet Med Sci. 1997; 59: 811-813
        • Chuang Y.C.
        • Fraser M.O.
        • Yu Y.
        • Chancellor M.B.
        • de Groat W.C.
        • Yoshimura N.
        The role of bladder afferent pathways in bladder hyperactivity induced by the intravesical administration of nerve growth factor.
        J Urol. 2001; 165: 975-979
        • Pacheco P.
        • Camacho M.A.
        • García L.I.
        • Hernández M.E.
        • Carrillo P.
        • Manzo J.
        Electrophysiological evidence for the nomenclature of the pudendal nerve and sacral plexus in the male rat.
        Brain Res. 1997; 763: 202-208