Fecal incontinence is a distressing condition with limited treatment options, leading to significant impairment in quality of life. A newly emerged viable treatments option has been recognized; however, its efficacy of Percutaneous Tibial Nerve Stimulation (PTNS) is still unknown. This systematic review evaluates existing evidence on PTNS efficacy in fecal incontinence management. A comprehensive search identified studies assessing PTNS in fecal incontinence. Data extraction and quality assessment were conducted. Findings suggest PTNS may improve symptoms and quality of life, but study heterogeneity and methodological limitations exist. Standardized protocols and long-term studies are needed for definitive conclusions. This review contributes to understanding PTNS efficacy and guides future research and clinical practice in fecal incontinence management.

To determine the effectiveness of PTNS as a treatment option for fecal incontinence, a systematic review methodology was used. To conduct the systematic review, a number of PubMed, EMBAS, and web of science and the Cochrane Library used to gather past studies in this field. These articles have appeared in peer-reviewed journals. The following keywords were entered into the search engine: “PTNS Bowel Control Treatment Outcomes Clinical Trials Randomized controlled trials (RCTs) Meta-analysis Long-term Follow-up Therapeutic Efficacy Patient-reported outcomes Adverse effects Neurostimulation therapy Quality life fecal incontinence Neuromodulation Tibial nerve stimulation. "

A combined total of 67 publications was identified through the use of the databases PubMed, EMBASE, Web of Science and the Cochrane Library. Following the elimination of 20 papers that were considered duplicated, A search was run through a total of 47 full-length articles that had the potential to be relevant. 47 articles were assessed for their level of relevance; as a result, 35 articles were excluded because 10 of them  were  not available in full-text or in English, 17 of them did not quantify satisfaction and 8 of them were similar to findings from earlier studies. After that, 12 different papers fulfilled all the requirements to be included.

Significant data regarding the efficacy of percutaneous tibial nerve stimulation (PTNS) as a treatment option for fecal incontinence (FI) is provided by the presented research studies, with each study highlighting a distinct facet of the treatment's potential and effectiveness.
Promising findings were obtained from the study that assessed the long-term effectiveness of PTNS over a number of years by conducting a prospective, interventional trial.Bosch-Ramírez, M., et al. (2023) , (Carrillo, R. R., et al. (2021).  It noted that PTNS, administered over a year in phases, led to optimal responses in a significant proportion of patients, with a notable percentage remaining optimal responders even at the 36-month mark. It's interesting to note that baseline variables like Wexner scores and the length of symptoms were found to be predictive of favorable reactions to PTNS with motor response during procedure. According to this, individuals with FI who are not responding to conservative therapy may benefit from PTNS over time, which could lessen the need for more invasive procedures.
Conversely, the aim of the comprehensive evaluation was to assess the effectiveness of PTNS in the context of various research studies and methodologies. (van der Wilt, A. A., et al (2017) , (Zyczynski, H. M., ert al. (2021). It discovered a considerable body of evidence demonstrating the usefulness of PTNS in improving treatment results, incontinence severity, and quality of life . Notably, the review found that PTNS was helpful in reducing the number of incontinence events while extending deferral time for defecation. However, it also recognized the necessity for long-term interventions to extend the effects of PTNS, emphasizing the importance of continued treatment in preserving advantages over time.
In contrast, the randomized controlled trial (RCT) comparing PTNS with sham stimulation for FI in women yielded mixed results (Horrocks, E. J., et al. (2014), (Hounsome, N., & Roukas, C. (2018), (Waked, I. S., & Seyam, M. K. (2018). While PTNS showed a reduction in symptoms after 12 weeks of treatment, this improvement did not significantly differ from the sham group. This suggests that while PTNS may offer some clinical benefit, its superiority over sham stimulation remains unclear based on these findings. However, it's important to note that this study focused specifically on women with FI refractory to first-line treatments, indicating a need for further research to determine the broader efficacy of PTNS across different patient populations.
Furthermore, The requirement of high-quality data for noninvasive second-line treatments for FI in the Neuromodulation for Accidental Bowel Leakage trial design is highlighted. By comparing it to sham stimulation and measuring multiple outcome indicators, the aim of this trial is to offer valuable insights into the efficacy and optimal maintenance therapy schedule of PTNS for refractory inadvertent bowel leakage. 
Overall, while some studies suggest promising outcomes for PTNS in the treatment of FI, others highlight the need for further research to clarify its efficacy and determine its role in clinical practice. Further investigation, including larger RCTs and long-term follow-up studies, will be essential for fully understanding the potential benefits of PTNS and optimizing its use in the management of FI.

In conclusion, PTNS appears to be a promising therapy option for fecal incontinence, with evidence suggesting that symptoms and quality of life can improve. However, to validate these findings and determine the appropriate application of PTNS treatments for fecal incontinence, more well-designed trials with bigger sample sizes and longer follow-up periods are required. Standardization of treatment techniques and a thorough study of adverse events will be crucial in directing clinical practice and improving the treatment of patients.

?	Simillis, C., Lal, N., Qiu, S., Kontovounisios, C., Rasheed, S., Tan, E., & Tekkis, P. P. (2018). Sacral nerve stimulation versus percutaneous tibial nerve stimulation for faecal incontinence: a systematic review and meta-analysis. International Journal of Colorectal Disease, 33, 645-648.
?	Bosch-Ramírez, M., Sánchez-Guillén, L., Alcaide-Quirós, M. J., Aguilar-Martínez, M. M., Bellón-López, M., López Delgado, A., ... & Arroyo, A. (2023). Long-term efficacy of percutaneous tibial nerve stimulation for faecal incontinence and a new approach for partial responders. Techniques in Coloproctology, 27(6), 443-451.
?	Carrillo, R. R., Carmona, M. D. R., Company, R. A., Caregnato, A. F., Iranzo, M. A., Bueno, A. S., ... & Ximénez, E. G. G. (2021). Importance of some technical aspects of the procedure of percutaneous posterior tibial nerve stimulation in patients with fecal incontinence. Cirugía Española (English Edition), 99(8), 585-592.