Näytönastekatsaukset

Percutaneous nerve stimulation in overactive bladder symptoms in women

Näytönastekatsaukset
31.3.2026
Olavi Airaksinen and Aleksi Raudasoja

Level of evidence: B

Percutaneous Tibial nerve stimulation (PTNS) likely decreases overactive bladder symptoms slightly.

Three randomized trials measured the effectiveness of tibial nerve stimulation to treat overactive bladder symptoms. One of the trials tested percutaneous nerve stimulation, had sham control and suggested a small benefit on overactive bladder symptoms on OAB-q scale «Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT t»1. Two of the trials measured the impact of transcutaneous nerve stimulation compared to no intervention and suggested a moderate to large impact on overactive bladder symptoms «Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a ran»2, «Schreiner L, Nygaard CC, Dos Santos TG, et al. Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial. Int Ur»3.

The level of evidence was downgraded due to high risk of bias.

Table 1. Description of the included studies.
Reference Study type Population Intervention and comparison Outcomes Risk of bias
MA=Meta-analysis
«Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT t»1 RCTWomen with Overactive Bladder symptoms PTNS vs sham OAB-qmoderate
«Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a ran»2RCTWomen with Overactive Bladder symptoms (daily urge incontinence episodes)Three arms: TTNS with sensory and TTNS with motor vs no treatment.Number of urge incontinence episodes, ICIQ-OAB high
«Schreiner L, Nygaard CC, Dos Santos TG, et al. Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial. Int Ur»3RCTWomen with Urge incontinence (daily urinary frequency) – age > 60 years.Kegel exercises and bladder retraining were performed alone or in combination with TTNSSUI and UUI episodes per 72h, ICIQ-SFhigh
Table 2. Additional comments for included studies.
Reference Comments
«Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT t»1 Risk of bias:
Randomization probably ok, concealment not reported
Blinding ok
Dropouts less than 10%
Outcomes badly reported
«Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a ran»2Risk of bias:
Randomization probably ok
No blinding
«Schreiner L, Nygaard CC, Dos Santos TG, et al. Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial. Int Ur»3Risk of bias:
Randomization probably ok
No blinding, outcome assessors probably blinded
Dropouts under 10%

Results

Table 3. Outcome 1: Change in OAB-q symptoms severity.
Reference Number of patients (I/C) Follow-up time Mean (SD) I Mean (SD) C Mean difference (95% CI)
Level of evidence: moderate
The level of evidence was downgraded one level due to study limitations and imprecision
*Calculated from the summary measures
I=intervention; C=comparison; CI=confidence interval
«Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT t»1101/102 13 weeks-36.7 (21.5)-29.2 (20.0)-7.5 (-1.8 to -13.2)*
Table 4. Outcome 2: Change in health-related quality of life (OAB-q, scale 25-150).
Reference Number of patients (I/C) Follow-up time Mean (SD) I Mean (SD) C Mean difference (95% CI)
Level of evidence: moderate
The level of evidence was downgraded one level due to study limitations and imprecision
I=intervention; C=comparison; CI=confidence interval
«Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT t»1103/10513 weeks34.2 (21.3)26.0 (20.6)8.2 (2.5 to 13.9)
Table 5. Outcome 3: Health-related quality of life (ICIQ-OAB, scale 0-16).
Reference Number of patients (I/C) Follow-up time Mean (SD) I Mean (SD) C Mean difference (95% CI)
Level of evidence: low
The level of evidence was downgraded due to study limitations and imprecision
* Pooled 3.68 (2.62)
**Calculated from the summary measures
I=intervention; C=comparison; CI=confidence interval
«Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a ran»233/30/254 weeks3.48 (2.45)
3.90 (2.82)*		8.60 (3.24)-4.92 (-3.60 to -6.24)**
Table 6. Outcome 4: Urge incontinence episodes per day.
Reference Number of patients (I/C) Follow-up time Mean (SD) I Mean (SD) C Mean difference (95% CI)
Level of evidence: low
The quality of evidence was downgraded due to high risk of bias.
*pooled 0.50 (1.26)
I=intervention; C=comparison; CI=confidence interval
«Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a ran»2 33/30/254 weeks0.26 (0.54)
0.77 (1.72)*		1.82 (1.60)-1.32 (-0.68 to -1.96)
«Schreiner L, Nygaard CC, Dos Santos TG, et al. Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial. Int Ur»351/5016 weeks0.6 (0.9)1.63 (1.2)-1.03 (-0.61 to -1.44)

References

  1. Peters KM, Carrico DJ, Perez-Marrero RA, 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(4):1438-43 «PMID: 20171677»PubMed
  2. Teixeira Alve A, Azevedo Garcia P, Henriques Jácomo R, et al. Effectiveness of transcutaneous tibial nerve stimulation at two different thresholds for overactive bladder symptoms in older women: a randomized controlled clinical trial. Maturitas 2020;135():40-46 «PMID: 32252963»PubMed
  3. Schreiner L, Nygaard CC, Dos Santos TG, et al. Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial. Int Urogynecol J 2021;32(3):687-693 «PMID: 33057739»PubMed