Posterior tibial nerve stimulation in adults with overactive bladder syndrome: A systematic review of the literature

Overactive bladder (OAB) is a common condition that can significantly impact on a patient's quality of life. Treatments include conservative methods (patient education, lifestyle modifications, bladder retraining), pharmacotherapy (anticholinergics and adrenoreceptor agonists), intravesical botulinum toxin A injections and surgical strategies (including neuromodulation, augmentation cystoplasty and urinary diversion). There has been increased interest in neuromodulation over recent years and accumulating evidence for percutaneous tibial nerve stimulation (PTNS). We have reviewed the currently available clinical evidence in a systematic, reproducible fashion. PTNS has been shown in randomised controlled studies (against sham/placebo and against anticholinergics) to be safe and effective in treating OAB. Cost effectiveness analyses for PTNS have shown mixed results depending on the length of follow-up. PTNS is a useful adjunct to therapy in OAB for patients who have failed conservative and pharmacotherapy. Further research is required to define its place in the OAB treatment algorithm.