Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report. Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder. The effect of EMG biofeedback assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women: A randomized controlled trial. Results of a prospective, randomized, multicenter study evaluating sacral neuromodulation with InterStim therapy compared to standard medical therapy at 6-months in subjects with mild symptoms of overactive bladder. Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study. Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial. Solifenacin Succinate versus Percutaneous Tibial Nerve Stimulation in Women with Overactive Bladder Syndrome: Results of a Randomized Controlled Crossover Study Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial. Percutaneous tibial nerve stimulation in the treatment of refractory overactive bladder syndrome: is maintenance treatment necessary? Combined Vaginal Pelvic Floor Electrical Stimulation (PFS) and Local Vaginal Estrogen for Treatment of Overactive Bladder (OAB) in Perimenopausal Females. Randomized Controlled Trial (RCT). Combination of sacral neuromodulation and tolterodine for treatment of idiopathic overactive bladder in women: a clinical trial. Transcutaneous posterior tibial nerve electrostimulation with low dose trospium chloride: Could it be used as a second line treatment of overactive bladder in females. Urodynamic results and clinical outcomes with intradetrusor injections of onabotulinumtoxinA in a randomized, placebo-controlled dose-finding study in idiopathic overactive bladder. Patient-Reported Side Effects of Intradetrusor Botulinum Toxin Type A for Idiopathic Overactive Bladder Syndrome Botulinum-A toxin detrusor and sphincter injection in treatment of overactive bladder syndrome: objective outcome and patient satisfaction. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. OnabotulinumtoxinA 100U provides significant improvements in overactive bladder symptoms in patients with urinary incontinence regardless of the number of anticholinergic therapies used or reason for inadequate management of overactive bladder A prospective randomised double-blind controlled trial evaluating the effect of trans-sacral magnetic stimulation in women with overactive bladder Single-blind, randomized trial of pelvic floor muscle training, biofeedback-assisted pelvic floor muscle training, and electrical stimulation in the management of overactive bladder. Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study.
INTRODUCTION This study compared percutaneous tibial nerve stimulation ( PTNS ) versus electrical stimulation with pelvic floor muscle training ( ES + PFMT ) in women with overactive bladder syndrome ( OAB ) . MATERIAL S AND METHODS 60 women with OAB were enrolled . Patients were r and omized into two groups . In group A , women underwent ES with PFMT , in group B women underwent PTNS . RESULTS A statistically significant reduction in the number of daily micturitions , episodes of nocturia and urge incontinence was found in the two groups but the difference was more substantial in women treated with PTNS ; voided volume increased in both groups . Quality of life improved in both groups , whereas patient perception of urgency improved only in women treated with PTNS .  Global impression of improvement revealed a greater satisfaction in patients treated with PTNS . CONCLUSION This study demonstrates the effectiveness of PTNS and ES with PFMT in women with OAB , but greater improvements were found with PTNS BACKGROUND Non-neurogenic overactive bladder ( OAB ) is a common problem in children that may affect their quality of life . Various methods of neuromodulation have been reported to treat refractory lower urinary tract dysfunction . Since most of these techniques are invasive , they are less applicable in children . OBJECTIVE To evaluate the efficacy of transcutaneous PTNS in treatment of OAB in children , in a r and omized clinical setting . STUDY DESIGN This study was single-blinded , prospect i ve , sham controlled r and omized trial . 40 children with non-neurogenic OAB refractory to behavioural and anticholinergic therapy were r and omized either to test group or sham group . Neuromodulation was performed using two self-adhesive electrodes cephalad to medial malleolus . In test group the stimulation was given with voltage pulse intensity of 0 to 10 mA , pulse width of 200 μs and frequency of 20 Hz . In sham group patch electrodes were applied to simulate the test group but no stimulation was given . In both groups , weekly session of 30 min was given for a period of 12 weeks . The OAB symptoms , severity of incontinence , number of voids daily ( NV ) , average voided volume ( AVV ) and maximum voided volume ( MVV ) were evaluated before and after treatment . RESULTS On assessment of subjective improvement of OAB symptoms , 66.66 % patients reported cure and 23.81 % patients reported significant improvement of symptoms in test group whereas in sham group only 6.25 % patients reported significant improvement . In test group 71.42 % patients reported complete improvement in incontinence whereas in sham group only 12.5 % patient reported complete improvement . The AVV , MVV and NV improved significantly in test group ( p < 0.001 ) as compared to sham group ( Table ) . DISCUSSION The present study is unique as none of the earlier studies in children were sham controlled . It is also first PTNS study in which patch electrodes were used ; therefore it is completely noninvasive . This technique provides better patient acceptability and compliance . This study proved that , there is a definite effect of PTNS as compared to placebo because when patients from sham group were treated actively , they responded well . The present study has few limitations as it has relatively short follow-up period of 12 weeks . Relapse of OAB symptoms and maintenance schedule of PTNS need to be assessed further . CONCLUSION Transcutaneous PTNS is superior to placebo in treatment of non-neurogenic overactive bladder in children . In view of its effectiveness and acceptability we believe that transcutaneous PTNS should be part of pediatric urology armamentarium for treatment of OAB OBJECTIVE To evaluate the efficacy of percutaneous tibial nerve stimulation ( PTNS ) , either alone or combined with an anticholinergic agent , in treating patients with an overactive bladder ( OAB ) in whom previous conservative treatment failed . MATERIAL AND METHODS In this study , we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011 . Patients were r and omly divided into three groups : Group 1 , PTNS group ; Group 2 , patients receiving an anticholinergic agent ; and Group 3 , patients receiving both PTNS and anticholinergic agent . PTNS treatment continued for 12 weeks with each session lasting 30 min . RESULTS All parameters of the bladder diary significantly improved in all groups ( p<0.05 ) . Similarly , all scores measured by question naires ( UDI-6 , IIQ-7 , and OABSS ) revealed significant improvements in all groups . When the improvements in symptoms were compared among the groups , there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2 . CONCLUSION PTNS is a safe , simple , and minimally invasive treatment modality in patients with OAB , and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail AIMS The overactive bladder syndrome ( OAB ) is defined as urinary urgency , usually accompanied by frequency and nocturia , with or without urgency urinary incontinence . Biofeedback-assisted pelvic muscle therapy ( BAPFMT ) is a first-line treatment option for OAB . The aims of this study were to determine the efficacy and effectiveness of BAPFMT on symptoms of OAB after 9 weeks of treatment and to detect changes EMG activity of individual pelvic floor muscles ( PFM ) with the MAPLe . METHODS Patients were r and omly divided into an intervention group that received BAPFMT with the MAPLe or into a control group which received only toilet behavior and lifestyle instructions . The Pelvic Floor Inventories ( PeLFIs ) , the King 's Health Question naire ( KHQ ) , a voiding dairy , a 24 h pad-test , and vaginal EMG registration of the pelvic floor with the MAPLe were used at inclusion and after 9 weeks follow-up to determine the effect of BAPFMT on complaints of OAB and Quality of Life ( QoL ) . RESULTS Fifty-eight patients were included . The PeLFIs , KHQ , voiding dairy , and 24 h pad-test showed significant improvements in the intervention group compared to the control group in complaints of OAB and QoL. EMG activity showed significant improvements for specific individual muscles at the different sides and depths for rest , maximal voluntary contraction , and endurance . CONCLUSIONS EMG BAPFMT is effective in the OAB syndrome in women . It significantly reduces symptoms and complaints of OAB and increases QoL for patients . It shows that EMG changes in individual PFM , measured with the MAPLe , are relevant and related to symptom reduction AIMS This prospect i ve , r and omized , multicenter trial evaluated the 6-month success rate of sacral neuromodulation ( SNM ) with InterStim ® Therapy versus st and ard medical therapy ( SMT ) for overactive bladder ( OAB ) . METHODS Enrolled subjects discontinued OAB medications prior to and during baseline data collection and were r and omized 1:1 to SNM or SMT . Subjects had bothersome symptoms of overactive bladder ( OAB ) including urinary urge incontinence ( ≥2 leaks/72 hr ) and /or urgency-frequency ( ≥8 voids/day ) . Subjects failed at least one anticholinergic medication , and had at least one medication not yet attempted . The primary objective was to compare OAB therapeutic success rate at 6 months between SNM and SMT . RESULTS Overall , 147 subjects were r and omized ( 70 to SNM and 77 to SMT ) ; 93 % were female and mean age was 58 . The primary intent to treat analysis showed OAB therapeutic success was significantly greater in the SNM group ( 61 % ) than the SMT group ( 42 % ; P = 0.02 ) . In the as treated analysis , OAB therapeutic success was 76 % for SNM and 49 % for SMT ( P = 0.002 ) . The SNM group showed significant improvements in quality of life versus the SMT group ( all P < 0.001 ) and 86 % of SNM subjects reported improved or greatly improved urinary symptom interference score at 6 months , compared to 44 % for SMT subjects . The device-related adverse event rate was 30.5 % and the medication-related adverse event rate was 27.3 % . CONCLUSIONS This study demonstrates superior objective and subjective success of SNM compared to SMT . SNM is shown to be a safe and effective treatment for OAB patients with mild to moderate symptoms . Neurourol . Urodynam . 34:224 - 230 , 2015 . © 2014 Wiley Periodicals , AIMS To evaluate the safety , sustained effectiveness , and treatment interval for percutaneous tibial nerve stimulation ( PTNS ) for overactive bladder ( OAB ) therapy through 24 months . METHODS A prospect i ve study following treatment success after 12 weekly PTNS treatments , subjects were prescribed a 14-week tapering protocol , followed by ongoing therapy with a Personal Treatment Plan determined by the investigator and subject to sustain subject OAB symptom improvement . Question naires were completed every 3 months , voiding diaries every 6 months ; adverse events were reported throughout . RESULTS Of 50 subjects enrolled , 35 remained in the study at 24 months . During the 24 months following initial treatment success and a 14-week tapering protocol , mean treatments per month was 1.3 . Voiding diary and OAB-q data demonstrate sustained improvement reported at 13 weeks through 24 months . Improvements in frequency , urge incontinence episodes , night-time voids and moderate-to-severe urgency episodes from voiding diaries at 6 , 12 , 18 , and 24 months were statistically significant compared to baseline ( prior to initial 12 weekly treatments ) . Compared to baseline , OAB-q symptom severity scores and health related quality of life scores were statistically significant for improvement at each tested time point . Five mild adverse events of unknown relation to treatment were reported . CONCLUSION Sustained safety and efficacy of PTNS were demonstrated over 24 months with initial success after 12 weekly treatments , followed by a 14-week prescribed tapering protocol and a Personalized Treatment Plan . With an average of 1.3 treatments per month , PTNS therapy is a safe , durable , and valuable long-term OAB treatment option to sustain clinical ly significant OAB symptom control ABSTRACT Purpose To assess effectiveness and durability of Solifenacin ( SS ) versus tibial nerve stimulation ( PTNS ) versus combination therapy ( PTNS + SS ) in women with overactive bladder syndrome ( OAB ) . Material s and Methods 105 women with OAB were divided r and omly into three groups of 35 patients each . In group A women received SS , in group B women underwent PTNS , in group C women underwent combination of PTNS + SS .  Improvements in OAB symptoms were assessed with OABSS question naire ; patients ’ quality of life was assessed with OAB-q SF question naire . Evaluation of effectiveness of treatments was performed with PGI-I question naire . OABSS and PGI-I were also assessed monthly for ten months . Results All treatments were effective on symptoms . PTNS showed a greater effectiveness than SS , but PTNS + SS was more effective than SS and PTNS . Furthermore , PTNS + SS showed a greater duration of effectiveness than PTNS and SS . Conclusions Combination of PTNS with SS showed more effectiveness and more durability than PTNS and SS alone Overactive bladder ( OAB ) is a disabling disorder . Treatment of cases with OAB includes behavioral , pharmacological , surgical interventions and peripheral electrical stimulation . The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder ( OAB ) . Fifty women were r and omly assigned to PTNS ( posterior tibial nerve stimulation ) plus tolterodine or tolterodine alone treatment . Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks . Two in PTNS group and 8 in the control group withdrew from the study . Age , education level , and occupation status were not significantly different between two groups . Mean total FSFI and its subscales were not significantly different before and after treatment between two groups . Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient 's control became significantly different after treatment between two groups . Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder Aims : This study compared the effectiveness of solifenacin succinate ( SS ) versus percutaneous tibial nerve stimulation ( PTNS ) in women with overactive bladder syndrome ( OABS ) . Methods : A r and omized controlled crossover study of 40 women with OABS was performed . Patients were r and omized into two groups . In group A , patients received SS and then PTNS . In group B , patients underwent PTNS and then SS .  Voiding diaries , quality of life surveys and patient perception of intensity of urgency question naire were performed before and after each treatment . The global impression of improvement question naire was performed at the end of the study . Results : A reduction in the number of daily micturitions , episodes of nocturia and urge incontinence were found with both SS and PTNS in all groups , but PTNS showed a greater effectiveness than SS . There was an increase in voided volume in all groups with both SS and PTNS , but patients treated with PTNS had a greater increase . PTNS showed greater effectiveness in patient perception of urgency and quality of life . Conclusion : This study demonstrates the effectiveness of SS and PTNS In women with overactive bladder symptoms . However , greater improvements were found with PTNS Introduction and hypothesisThis study evaluated the efficacy and tolerability of transcutaneous posterior tibial nerve stimulation ( TPTNS ) in the treatment of overactive bladder ( OAB ) after failure of a first-line anticholinergic treatment . Material s and methods We performed a prospect i ve observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment from November 2010 to May 2013 . The protocol consisted of daily stimulation at home . The efficacy end point was defined as improvement on the Urinary Symptom Profile ( USP ) and the French-vali date d urinary symptom score Mesure du H and icap Urinaire ( MHU ) . Results We assessed 43 consecutive patients . TPTNS was successful following 1 month of treatment in 23 ( 53 % ) patients . Bladder capacity was the only predictive factor for treatment success ( p = 0.044 ) . For patients who showed improved symptoms ( n = 23 ; 53 % ) , mean MHU and USP decreased significantly , from 11.8 ± 2.8 to 5.6 ± 3 ( p < 0.001 ) and from 14 ± 3.3 to 6.9 ± 3.2 ( p < 0.001 ) , respectively . After a mean follow-up of 10.8 ± 1.6 months , 21 ( 49 % ) patients continued the TPTNS . Mean MHU and USP scores were 4.4 ± 2.8 and 5.4 ± 3.5 , respectively , and stayed lower than baseline ( p < 0.001 ) . Patients reported no adverse events . Conclusion TPTNS is well tolerated and is effective in one half of the patients studied after they failed anticholinergic treatment . TPTNS could become a second therapeutic option before surgical treatment in the management strategy of OAB INTRODUCTION AND HYPOTHESIS The aim of this study was to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation ( T.C. PTNS ) versus extended release oxybutynin ( E.R.O. ) in patients with overactive bladder . MATERIAL S AND METHODS Seventy female patients were r and omized to receive either 10 mg E.R.O. daily or T.C. PTNS , using a TENS machine program with the 20Hz , 200 cycles/s , and normal stimulation setting for two 30-min sessions , each week for a 12-week period . Pre-treatment and after the 12-week intervention , each patient completed a 3-day voiding diary and a  self-report quality of life question naire ( OAB-q ) . Statistical analysis was performed using Stata V12.1 . RESULTS Sixty-four patients completed the treatment protocol . There were no significant differences between study groups in terms of age , body mass index , past hormone replacement therapy , smoking habits , menopause status , and parity . Prior to treatment , there were also no significant differences in the analysis of the 3-day voiding diary or in the OAB-q question naire results . Following the 12-week study , there was a statistically significant reduction in frequency of urination , urgency episodes , and urge incontinent episodes compared to pre-treatment values . However , there were no significant differences in these values between intervention groups after 12-weeks of therapy . There was a similar improvement in OAB-q scores in both treatment groups following therapy , and the T.C. PTNS group showed a statistically significant improvement over the E.R.O. in domain 2 of the OAB-q question naire . The other two domains showed similar improvement in both study groups . CONCLUSION T.C. PTNS and E.R.O. demonstrated similar improvements in subjects with OAB in a 12-week study To determine the effect of a pause in percutaneous tibial nerve stimulation ( PTNS ) in successfully treated patients with an overactive bladder ( OAB ) , and the reproducibility of successful treatment when restored OBJECTIVE To evaluate the efficacy of combined vaginal pelvic floor electrical stimulation ( PFS ) and local vaginal estrogen in treatment of female overactive bladder ( OAB ) . MATERIAL AND METHODS This is a r and omized controlled trial carried out on 315 perimenopausal females with OAB who were r and omly allocated into 3 equal groups . Group A underwent PFS using vaginal probes twice weekly for 12 sessions . Group B received local vaginal estrogen , whereas group C received both PFS and local estrogen . All patients were evaluated by a voiding diary , quality -of-life question naire , vaginal examination , urine analysis , blood sugar , ultrasonography , and urodynamic study before and after therapy . Patients were followed up 1 week , 3 , and 6 months post-therapy . The analyzed variables included day and night time frequency , incontinence episodes , urgency , quality of life , detrusor overactivity ) , and functional bladder capacity ) . Outcome measure was urge incontinence . RESULTS Within each group , there was a statistically significant improvement in all variables after treatment . Improvement of urgency was better in group C than in groups A and B ( P = .000 , .009 ) . Improvement of incontinence was better in groups A and C than in group B ( P = .005 , .004 ) . Follow-up showed worsening of symptoms within 6 months in all groups except incontinence in group C. CONCLUSION Vaginal PFS and estrogen found to be effective in treating OAB symptoms in perimenopausal females . Estrogen seems to augment the effect of PFS especially in the treatment of urgency incontinence and can delay its recurrence PURPOSE To evaluate the efficacy of intermittent percutaneous needle sacral nerve stimulation ( IPN-SNS ) in women with idiopathic overactive bladder ( IOAB ) treated with tolterodine . MATERIAL S AND METHODS A total of 240 female patients diagnosed with IOAB were r and omized to receive tolterodine only treatment ( group 1 , n = 120 ) or tolterodine combined with IPN-SNS ( group 2 , n = 120 ) . Each group included 120 participants , who were divided into subgroups depending on whether they had dry OAB ( urinary frequency and urgency ) or wet OAB ( urinary frequency and urgency with urgency incontinence ) . In the treatment group , patients received percutaneous IPN-SNS plus tolterodine ( 2 mg once daily ) , while in the control group , only tolterodine ( 2 mg once daily ) was administered for 3 months . The voiding diary and urodynamic parameters were monitored , and patients ' psychological depression and anxiety scores were recorded before and after treatment . RESULTS There were significantly greater improvements in the conditions of first desire to void ( FDV ) , max­imum cystometric capacity ( MCC ) , and daily average volumes , as well as the daily single maximum voided volumes in group 2 ( P = .001 ) than in group 1 . In addition , there were significantly greater decreases in self-rating depression scale ( SDS ) and self-rating anxiety scale ( SAS ) scores in group 2 compared with group 1 ( P < .001 ) . CONCLUSION Combined treatment with tolterodine plus IPN-SNS can not only improve the symptoms of voiding dysfunction but can also reduce the concomitant depression and anxiety in women with IOAB , there­by improving patients ' quality of life AIM To evaluate the effect of adding low dose trospium chloride with transcutaneous posterior tibial nerve stimulation ( TPTNS ) in the treatment of overactive bladder ( OAB ) in females after failure of behavioral therapy . METHODS We r and omized 30 women with OAB , in two groups : G I received 30 min TPTNS , three times a week ; GII received TPTNS plus 20 mg trospium chloride daily . OAB Symptom Score question naire ( OABSS ) , Incontinence Impact Question naire-short form 7 ( IIQ-7 ) , 3 day voiding diary and urodynamics at weeks 0 and 8 were evaluated . RESULTS The groups were similar before treatment . Eight weeks after treatment , the mean OABSS decreased significantly to 8.53 ± 1.30 for group II vs 10.0 ± 2.0 for GI ( P < 0.024 ) . The mean IIQ-7 score decreased significantly to 51.86 ± 17.26 in group I vs 31.99 ± 9.26 in group II ( P < 0.001 ) . Before treatment , 11 ( 73.3 % ) and 4 ( 26.7 % ) patients in each group had moderate and poor quality of life ( QoL ) , respectively . After treatment , 6 ( 40 % ) and 14 ( 93.3 % ) had good QoL , 7 ( 46.7 % ) and 1 ( 6.7 % ) had moderate QoL in GI and GII , respectively . Two ( 13.3 % ) patients in GI had poor QoL. The mean frequency was reduced to 8.60 ± 0.83 vs 10.60 ± 2.32 for GII and GI respectively ( P = 0.006 ) . The cystometric capacity increased from 263.40 ± 50.45 to 377.80 ± 112.92 mL ( P = 0.001 ) for GII vs 250.13 ± 56.24 to 296.40 ± 99.0 mL ( P = 0.026 ) for GI . CONCLUSION TPTNS combined with low dose trospium chloride proved to be more effective than TPTNS alone in the treatment of OAB in females AIMS We assessed the effects of onabotulinumtoxinA ( BOTOX ® ) on clinical and urodynamic variables in patients with idiopathic overactive bladder ( OAB ) and urinary urgency incontinence ( UUI ) with or without detrusor overactivity ( DO ) , inadequately managed with anticholinergics . METHODS Three hundred thirteen patients with OAB were r and omized to double-blind intradetrusor injection with placebo ( n = 44 ) or 1 of 5 onabotulinumtoxinA doses ( 50 - 300 U ; n = 269 ) . Primary efficacy variable was change from baseline in UUI episodes/week at week 12 . Urodynamic assessment s at baseline and weeks 12 and 36 included maximum cystometric capacity ( MCC ) and volume at first involuntary detrusor contraction ( IDC ) . RESULTS 76.0 % of patients had baseline DO . Changes from baseline in MCC and volume at first IDC with onabotulinumtoxinA ≥100 U were superior to placebo at week 12 , generally decreasing by week 36 . Significant dose-dependent increases in MCC were observed for all onabotulinumtoxinA doses at week 12 , and for 150 , 200 , and 300 U at week 36 . Data suggested a dose-response relationship . At week 12 on diary , 15.9 % of placebo and 29.8 - 57.1 % of onabotulinumtoxinA 50 - 300 U recipients , respectively , did not demonstrate UUI . OnabotulinumtoxinA doses > 150 U were more commonly associated with post-void residual urine volumes > 200 ml . CONCLUSIONS Improvements in urodynamic parameters and clinical outcomes generally trended together following onabotulinumtoxinA treatment . This therapy improved key urodynamic parameters in patients with idiopathic OAB and UUI , with no differences in outcomes between those with and those without baseline DO . Therefore , successful idiopathic OAB treatment with onabotulinumtoxinA does not appear to be related to pretreatment finding of DO Objective : The aim of the study was a prospect i ve assessment of patient-reported side effects in an open-label study after intradetrusor botulinum toxin injections for idiopathic overactive bladder ( OAB ) . Patients and Methods : Botulinum toxin A injection was performed in 56 patients with idiopathic OAB . Patients were followed up for 6 months concerning side effects and patients ’ satisfaction . Results : Different types of side effects were assessed such as dry mouth ( 19.6 % ) , arm weakness ( 8.9 % ) , eyelid weakness ( 8.9 % ) , leg weakness ( 7.1 % ) , torso weakness ( 5.4 % ) , impaired vision ( 5.4 % ) and dysphagia ( 5.4 % ) . In all cases , symptoms were mild and transient . Urological complications such as gross hematuria ( 17.9 % ) , acute urinary retention ( 8.9 % ) and acute urinary tract infection ( 7.1 % ) were noticed . In all cases , acute urinary retention was transient and treated with temporary intermittent self-catheterization . There was no statistically significant correlation between dosage and observed side effects . Patients ’ satisfaction rate was high ( 71.4 % ) . Conclusion : Intradetrusor injection of botulinum toxin was associated with a high rate of neurourological side effects . In general , side effects were transient , mild and did not require special treatment OBJECTIVE We investigated the effect of botulinum-a toxin injections into the detrusor and external sphincter muscle in patients with overactive bladder ( OAB ) symptoms . METHODS We included 44 patients - 41 women and three men with a mean age of 66.1 years - who were suffering from OAB symptoms that were refractory to anticholinergic treatment . We injected 200 - 300 U of BTX-A ( Botox ) into the detrusor muscle ; 22 patients also received external sphincter injections . For outcome analysis , we used a bladder diary , a urodynamic examination , and a question naire that consisted of 27 vali date d questions . RESULTS Changes in the bladder diary 4 weeks and 3 , 6 , and 9 months after BTX-A injection were as follows : Micturition frequency was reduced by 12 % , 16 % , 13 % and 9 % , respectively . Average pad use decreased from 4.2 pads per day to at most 2.4 pads per day after 6 months . Urodynamic changes were most distinct after 4 weeks : the volume when the first uninhibited detrusor contraction occurred increased from 149+/-18.2 mL to 263 + /- 24.2 mL , and maximum cystometric bladder capacity increased from 228 + /- 19.2 mL to 305 + /- 19.0 mL. Subjectively , 86 % of the patients would choose this procedure for their bladder condition again . Residua 4 weeks after additional injection into the sphincter muscle were distinctly smaller than in the " only detrusor " group . CONCLUSIONS BTX-A detrusor and sphincter injection is very effective in treating OAB symptoms . For patients who might be expected to have residual urine after injection only into the detrusor , additional injection of low doses of BTX-A into the external sphincter muscle could be one option to reduce that risk BACKGROUND Overactive bladder ( OAB ) syndrome with urinary incontinence ( UI ) is prevalent in the population and impairs health-related quality of life ( HRQOL ) . OBJECTIVE To assess the impact on efficacy , safety , and HRQOL of onabotulinumtoxinA ( BOTOX ( ® ) , Allergan , Inc. ) treatment in patients with OAB with UI . DESIGN , SETTING , AND PARTICIPANTS This pivotal , multicentre , double-blind , r and omised , placebo-controlled , phase 3 study enrolled patients with idiopathic OAB with ≥ 3 urgency UI episodes over 3 d and ≥ 8 micturitions per day who were inadequately managed by anticholinergics . INTERVENTION OnabotulinumtoxinA at a 100U dose ( n=277 ) or placebo ( n=271 ) , administered as 20 intradetrusor injections of 0.5 ml . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Co- primary end points were change from baseline in the number of UI episodes per day and proportion of patients reporting positive treatment response on the treatment benefit scale ( TBS ) at week 12 . Additional end points included other OAB symptoms ( episodes of urinary urgency incontinence , micturition , urgency , and nocturia ) and HRQOL ( Incontinence Quality of Life [ I-QOL ] , King 's Health Question naire [ KHQ ] ) . Safety assessment s included adverse events ( AEs ) , postvoid residual ( PVR ) urine volume , and initiation of clean intermittent catheterisation ( CIC ) . RESULTS AND LIMITATIONS OnabotulinumtoxinA significantly decreased UI episodes per day at week 12 ( -2.95 for onabotulinumtoxinA versus -1.03 for placebo ; p<0.001 ) . Reductions from baseline in all other OAB symptoms were also significantly greater following onabotulinumtoxinA compared with placebo ( p ≤ 0.01 ) . Patients perceived a significant improvement in their condition , as measured by patients with a positive treatment response on the TBS ( 62.8 % for onabotulinumtoxinA versus 26.8 % for placebo ; p<0.001 ) . Clinical ly meaningful improvements from baseline in all I-QOL and KHQ multi-item domains ( p<0.001 versus placebo ) indicated positive impact on HRQOL . AEs were mainly localised to the urinary tract . Mean PVR was higher in the onabotulinumtoxinA group ( 46.9 ml versus 10.1 ml at week 2 ; p<0.001 ) ; 6.9 % of onabotulinumtoxinA patients versus 0.7 % of placebo patients initiated CIC . CONCLUSIONS OnabotulinumtoxinA 100 U was well tolerated and demonstrated significant and clinical ly relevant improvements in all OAB symptoms , patient-reported benefit , and HRQOL in patients inadequately managed by anticholinergics . TRIAL REGISTRATION Clinical Trials.gov : NCT00910520 Introduction A prespecified pooled analysis of two placebo-controlled , phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder ( OAB ) patients with urinary incontinence ( UI ) . Methods Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo , sparing the trigone . Change from baseline at week 12 in UI episodes/day , proportion of patients reporting a positive response ( ‘ greatly improved ’ or ‘ improved ’ ) on the treatment benefit scale ( TBS ) , micturition and urgency were evaluated by number of prior anticholinergics ( 1 , 2 or ≥ 3 ) and reason for their discontinuation ( insufficient efficacy or side effects ) . Adverse events ( AE ) were assessed . Results Patients had taken an average of 2.4 anticholinergics before study enrolment . OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo , regardless of the number of prior anticholinergics ( −2.82 vs. −1.52 for one prior anticholinergic ; −2.58 vs. −0.58 for two prior anticholinergics ; and −2.92 vs. −0.73 for three or more prior anticholinergics ; all p < 0.001 ) . The proportion of TBS responders was higher with onabotulinumtoxinA vs. placebo ( 69.0 % vs. 37.2 % for one prior anticholinergic ; 58.8 % vs. 24.8 % for two prior anticholinergics and 56.4 % vs. 22.5 % for three or more prior anticholinergics ; all p < 0.001 ) . Similar results were observed regardless of the reason for discontinuation . OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups . AEs were well tolerated , with a comparable incidence in all groups . Conclusion In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics , onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB . Clinical Trials.gov : NCT00910845 , NCT00910520 Overactive bladder ( OAB ) is a prevalent condition with 16 % of adults having one or more symptoms that significantly affect quality of life .  Transcutaneous electrical nerve stimulation and neuromodulators have had success in treating OAB but are expensive , invasive , and sometimes cumbersome . We developed an alternative neuromodulatory technique that involves electromagnetic stimulation of the sacral nerve roots with a portable electromagnetic device to produce trans-sacral stimulation of the S3 and S4 sacral nerve roots . The aim of this study was to evaluate the impact of this device on  OAB  symptoms in women with a prospect ively r and omised double-blind controlled study . Following a power analysis , women with symptoms of OAB were prospect ively recruited with ethical approval for r and omisation to an  active treatment ( n = 33 ) or placebo group ( n = 30 ) in a double-blind trial . The patient , at home , used the belt device daily for 20 min over 12 weeks . Outcome measures included a 3-day voiding diary , 1 h pad test , visual analogue score ( VAS ) for symptom impact ( 0–100 % ) , Kings Health Question naire ( KHQ ) and Australian Quality of Life question naire ( AQOL ) at baseline , 6 and 12 weeks . Overall , no difference was found between groups for any of the research questions . Specifically , we were unable to demonstrate any difference between the active and sham device groups in frequency , nocturia , urinary leakage , or quality of life , nor was there any evidence of a placebo effect . The quality of the data was high with the number of missing observations ( especially for disease specific KHQ and general AQOL ) being few . This attempt to promote trans-sacral electromagnetic neuromodulation with a specially created device was ineffective on the symptoms of OAB OBJECTIVES To compare the efficacy of pelvic floor muscle training ( PFMT ) , biofeedback-assisted PFMT ( BAPFMT ) , and electrical stimulation ( ES ) in the management of overactive bladder ( OAB ) .  METHODS The interventions for the 12-week treatment period , conducted by the physiotherapist who was unaware of the progress and outcome , included ( a ) a PFMT program tailored to the subject 's PERFECT ( power , endurance , repetitions , and fast [ 1-second ] contractions , with every contraction timed ) scheme , used for training at home ; ( b ) an electromyography BAPFMT program and home program tailored to the subject 's PERFECT scheme ; and ( c ) an ES program using biphasic symmetric probe current with 10-Hz frequency , 400-micros pulse width , 10/5 duty cycle , and varying intensity . Identical preintervention and postintervention assessment included King 's Health Question naire , as well as outcomes of urge incontinence and other urinary symptoms . RESULTS Of the 103 women who completed this study , 34 were in the PFMT group , 34 in the BAPFMT group , and 35 in the ES group . The changes in the three parameters of King 's Health Question naire revealed statistically significant differences , except for the total score , between ES and BAPFMT ( domain 7 , P = 0.003 ; domain 9 , P = 0.029 ; and total score , P = 0.952 ) . These same parameters were significantly different between ES and PFMT ( domain 7 , P = 0.007 ; domain 9 , P = 0.001 ; and total score P = 0.004 ) . The change in total score was significantly different between BAPFMT and PFMT ( P = 0.003 ) . The subjective improvement/cure rate of OAB was 51.4 % for ES , 50.0 % for BAPFMT , and 38.2 % for PFMT ( P = 0.567 ) . CONCLUSIONS ES had the greatest subjective reduction rate of OAB and was the most effective of the three treatments . BAPFMT was more effective than PFMT AIMS Electrostimulation is an established therapeutic option for neurogenic urinary disorders . The aim of this study was to investigate the efficacy of the noninvasive technique of transcutaneous posterior tibial nerve stimulation ( TPTNS ) in patients with multiple sclerosis ( MS ) and troublesome symptoms of an overactive bladder ( OAB ) . METHODS A multicentric study enrolled 70 MS patients , suffering from OAB for a 3-month study period . INTERVENTION Daily sessions of 20 min of TPTNS were provided . No change of associated treatments during the study period . The primary outcome measurement was Urgency and Frequency reported by bladder diary and symptom score performed before the treatment ( Day 0 , D0 ) and at D30 and D90 . The secondary outcomes measurements were continence , symptom score , quality of life , psychosocial burden at DO , D30 , and D90 and cystometry at baseline , with and without TPTNS and at D90 . RESULTS Clinical improvement of OAB was shown in 82.6 % and 83.3 % of the patients on D30 and D90 , respectively , with significant improvement of primary and secondary outcomes compared to baseline . The initial acute cystometric response to TPTNS was positive in 51.2 % of the patients ( increase of > 30 % of cystometric capacity and /or reflex volume ) , without correlation with TPTNS clinical efficiency . The procedure was well tolerated . CONCLUSIONS Chronic TPTNS appears to be effective in the management of severe OAB in MS , without compromising bladder emptying or inducing side effect . Treatment may be effective even in the absence of an acute cystometric effect . Additional works are required to demonstrate long-term efficacy of TPTNS
Combination therapy studies of third-line treatments were rare and centered on medication with PTNS .
Combination therapy , with certain first , second , and third-line OAB therapies , appears to be efficacious .
AIMS Overactive bladder ( OAB ) affects over 17 % of the population and significantly effect the health-related quality of life .
The treatments for OAB include first line ( lifestyle modification , pelvic floor muscle training ) , second line ( anticholinergic or beta-3 agonist medications ) , and third line therapies ( intradetrusor botulinum toxin injection , sacral neurostimulation [ SNM ] , or percutaneous tibial nerve stimulation [ PTNS ] ) .
For those with urinary incontinence secondary to OAB , complete continence is the goal of therapy , though cure rates are only 5 % to 40 % .
The use of combination therapies can be employed in refractory OAB , however , the efficacy of pooled modalities is relatively unknown .
Our objective was to determine the volume of data supporting combination therapy in treating OAB .