Comparison of Different Types of Therapy for Overactive Bladder: A Systematic Review and Network Meta-Analysis

To compare the efficacy and safety of different interventions (including Antimuscarinics, Mirabegron, OnabotulinumtoxinA, sacral neuromodulation (SNM) and peripheral tibial nerve stimulation (PTNS)) on idiopathic overactive bladder (OAB). PubMed, Embase, Cochrane library, and other sources were searched for randomized controlled trials (RCTs) comparing interventions of OAB from 1 January 2000 to 19 April 2021. A systematic review and network meta-analysis were performed by two authors independently. 55 RCTs involving 32,507 patients were included in this network. Overall, Antimuscarinics, Mirabegron, OnabotulinumtoxinA, SNM, and PTNS were more efficacious than placebo and SNM showed the best effect for reducing micturition frequency, urgency episodes and urgency urinary incontinence episodes. OnabotulinumtoxinA was the best in achieving reduction of 100% and ≥50% in the number of urinary incontinence episodes /day and PTNS was the best in reducing urinary incontinence episodes. The efficacy of Antimuscarinics, Mirabegron and PTNS were similar in reducing micturition frequency, urinary incontinence episodes and urgency urinary incontinence episodes. The results revealed that all interventions included in the network were efficacious in managing adult OAB syndrome compared with placebo. Furthermore, SNM and OnabotulinumtoxinA were the most efficient treatments for overactive bladder.

Tibial nerve stimulation increases vaginal blood perfusion and bone mineral density and yield load in ovariectomized rats

ABSTRACTHuman menopause transition and post-menopausal syndrome, driven by reduced ovarian activity and estrogen levels, are associated with an increased risk for symptoms including but not limited to sexual dysfunction, metabolic disease, and osteoporosis. Current treatments (both hormonal and non-hormonal) are limited in efficacy and may have adverse consequences, so investigation for additional treatment options is necessary. Previous studies have demonstrated that tibial nerve stimulation or electro-acupuncture near the tibial nerve are minimally invasive treatments that increase vaginal blood perfusion or serum estrogen in the rat model. In this study we examined the effects of twice weekly tibial nerve stimulation (0.2 ms pulse width, 20 Hz, 2x motor threshold) under ketamine-xylazine anesthesia in ovariectomized (OVX) female Sprague Dawley rats on menopause-associated physiological parameters. Rats were split into three groups (n = 10 per group): 1) intact control (no stimulation), 2) OVX control (no stimulation), and 3) OVX stimulation (treatment group). Tibial nerve stimulation did not increase serum estradiol levels, but transiently increased vaginal blood perfusion during stimulation for up to 5 weeks after OVX and increased areal bone mineral density and yield load of the right femur (side of stimulation) compared to the unstimulated OVX control. Additional studies to elucidate the full potential of tibial nerve stimulation on menopause-associated symptoms under different experimental conditions are warranted.SummaryPercutaneous tibial nerve stimulation increases vaginal blood perfusion, areal bone mineral density, and femur yield load in an ovariectomized rat model of menopause.

Self-management of overactive bladder at home using transcutaneous tibial nerve stimulation: a qualitative study of women’s experiences

Background Transcutaneous tibial nerve stimulation (TTNS) has been used to treat overactive bladder (OAB), however patient experiences and views of this treatment are lacking. The aim of this study was to explore women’s experiences of OAB and TTNS treatment and the perceived factors influencing participation and adherence. Methods Semi-structured, individual interviews conducted as part of a mixed-methods, randomised, feasibility trial of self-managed versus HCP-led TTNS. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis was undertaken using Booth et al. (Neurourol Urodynam. 2017;37:528–41) approach. Results 16 women were interviewed, 8 self-managing TTNS at home and 8 receiving TTNS in twice-weekly hospital clinic appointments. Women self-managing OAB considered TTNS easy to administer, flexible and favourably ‘convenient’, especially when the participant was bound by work and other life commitments. In contrast to OAB symptoms ‘dominating life’, self-managing bladder treatment was empowering and fitted around home life demands. Flexibility and control engendered by self-management, facilitated women’s willingness to participate in TTNS. Women attending a hospital clinic for TTNS enjoyed the social aspects but found the routine appointments constrained their lives. Motivation to continue TTNS in the longer term was dependent on perception of benefit. Conclusions This study provides novel insights into women’s experiences of self-managing their OAB using TTNS compared to HCP-led management in the clinical setting. It highlights positive experiences self-managing TTNS at home and a willingness to continue in the longer term, facilitated by ease of use and convenience. Trial Registration 1/11/2018: ClinicalTrials.gov Identifier: NCT03727711.

Comparison of the Effect of Percutaneous Tibial Nerve Stimulation (PTNS) with Medical Treatment in Patients with Overactive Bladder

Introduction: Overactive bladder (OAB) is a common problem that involves therapeutic challenges. Therefore, finding new and effective treatment modalities in these patients is essential. The aim of this study was to compare the therapeutic effect of percutaneous tibial nerve stimulation (PTNS) with drug therapy in patients with OAB. Methods: In this randomized controlled clinical trial, 74 patients with OAB were randomly divided into two groups: PTNS (twice a week for 12 weeks) and drug treatment (Solifenacin 10 mg daily for 12 weeks). OAB Symptom Score, q-OAB and Health-Related Quality of Life Questionnaire (HRQL) were completed and then compared at the beginning and end of the study for the two groups. Findings were analyzed using SPSS software version 20. Results: The drug intervention group consisted of 33 (89.2%) females and 4 males (10.81%), and PTNS group consisted of 31 females (83.8%) and 6 males (16.21%), (P = 0.496). Mean quality of life score, mean OABSS score, OAB screening score and urinary incontinence in both groups before the intervention did not show a statistically significant difference. After treatment, the mean quality of life in both groups increased significantly compared to before the intervention, but this increase was significantly higher in PTNS when compared with other group (74.2±6.9 vs. 68.9± 7.3). The mean OABSS score, OAB screening score and urinary incontinence in both groups decreased significantly compared to before treatment, but the mean OABSS score and OAB and urinary incontinence screening scores showed a significant decrease in PTNS group compared to drug treatment. Conclusion: Based on the findings, PTNS was found to be more effective than drug treatment in increasing the quality of life and controlling symptoms of OAB.