Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: results of a multicenter prospective study. Transcutaneous posterior tibial nerve stimulation: evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder. Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial. Neuromodulative treatment of overactive bladder--noninvasive tibial nerve stimulation. Transcutaneous posterior tibial nerve stimulation in pediatric overactive bladder: A preliminary report. Transcutaneous posterior tibial nerve stimulation versus extended release oxybutynin in overactive bladder patients. A prospective randomized trial. Percutaneous tibial nerve stimulation versus electrical stimulation with pelvic floor muscle training for overactive bladder syndrome in women: results of a randomized controlled study. Impact of a health education intervention in overactive bladder patients. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, 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 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 for the Treatment of Patients with Overactive Bladder and Urinary Incontinence: Results of a Phase 3, Randomized, Placebo Controlled Trial Management of refractory overactive bladder in children by transcutaneous posterior tibial nerve stimulation: A controlled study. Prospective and randomized comparison of electrical stimulation of the posterior tibial nerve versus oxybutynin versus their combination for treatment of women with overactive bladder syndrome [Posterior tibial nerve stimulation in the management of overactive bladder: a prospective and controlled study]. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial.
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 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 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 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 BACKGROUND Conservative treatment of overactive bladder employes behavioral or invasive neuromodulatory inhibition of miction reflex and administration of anticholinergic drugs . MAIN PURPOSE The aim of this study was to use non-invasive stimulation of the tibial nerve with the intention to achieve desired therapeutic effects without iatrogenic nerve damage using a superficial electrostimulation . METHODS All patients suffered from overactive bladder ( OAB ) without bladder outlet obstruction . OAB was examined by the Behavioral urge score BUS ( 0.0 - -the best and 1.0 - -the worst score ) , the International prostate symptom score IPSS ( 0 - -the best and 35 - -the worst score ) and the Incontinence quality of life question naire IQOL ( 0.0 - -the worst and 1.0 - -the best index ) . The patients were divided into 3 groups : Group I-- patients with electrode attached behind the medial ankle of the left lower extremity . The intensity of stimulation corresponded to 70 % of the maximum amplitude of response from musculus abductor hallucis . Frequency of stimulation was 1 Hz and duration of the square impulse was 0.1 ms . Surface stimulation lasted 30 minutes and was repeated once a week . Group II-- patients were treated by oral oxybutynin 5 mg t.i.d . Group III-- patients without treatment . The BUS , IPSS , and IQOL were repeated after the treatment . RESULTS The study included 28 females of average age 54 year ( range 45 to 63 ) . Mean IPSS was 17 ( range 12 to 21 ) , mean index of quality of life IQOL was 30 ( range 12 to 78 ) and mean BUS score was 0.68 ( range 0.50 to 0.86 ) . Group I with stimulation did achieve statistically significant changes following the treatment : decrease of mean IPSS from 17 + /- 3 points to 6 + /- 4 points after the treatment , increase in mean IQOL from 36 + /- 10 to 68 + /- 20 and decrease of mean BUS from 0.65 + /- 0.12 to 0.43 + /- 0.16 . Group II had similar statistically significant differences after the treatment of OAB . Group III noted no changes in the complaints . CONCLUSION Noninvasive stimulation had improved subjective symptom related to overactive bladder , had no adverse events and was well tolerated . ( Fig. 1 , Tab . 1 , Ref . 18 . ) 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 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 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 OBJECTIVE To assess a st and ardized and simple educational intervention in overactive bladder ( OAB ) patients to improve compliance with anticholinergic medication , increase the use of concomitant behavioral treatments , and improve patients ' perception of bladder symptoms . MATERIAL S AND METHODS This is a 16-week open-label r and omized trial of tolterodine combined with an education intervention for the experimental group versus tolterodine alone ( no intervention ) for the control group . The setting was in family medicine and urology clinics in Ontario . The participants were male and female adults with OAB symptoms . Both groups received tolterodine prescriptions . The intervention patients received printed information and an explanation about OAB , medication use , and behavioral treatments ( kegel exercise , bladder stretching , fluid regulation ) . The primary outcomes were medication compliance and persistence at 16 weeks . Secondary outcomes were use of behavioral treatments and self-reported severity of symptoms . RESULTS More patients in the intervention group ( experimental ) purchased their prescriptions ( p<0.05 ) . Compliance rate was greater for the intervention group ( 39 % ) , versus the control group ( 31 % ) at 16 weeks although the difference was not significant ( p>0.05 ) . Significantly more patients started and /or continued non-drug treatments in the intervention group ( 82 % ) compared to the control group ( 53 % ) ( p<0.05 ) . Furthermore , more patients in this group reported improvement in severity of bladder symptoms ( p<0.05 ) . CONCLUSIONS The simple education intervention result ed in a greater , but not significant , increase in compliance with medication compared to the control group . It also result ed in a significantly increased use of behavior modification therapies and better self-perception of treatment outcome PURPOSE Overactive bladder affects 12 % to 17 % of the general population and almost a third experience urinary incontinence , which may severely impact health related quality of life . Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects , leading to a high discontinuation rate . We report the results of the first large ( 557 patients ) , phase 3 , placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics . MATERIAL S AND METHODS Eligible patients with overactive bladder , 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were r and omized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo . Co- primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12 . Secondary end points included other overactive bladder symptoms and health related quality of life . Adverse events were assessed . RESULTS OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes vs placebo ( -2.65 vs -0.87 , p < 0.001 ) and 22.9 % vs 6.5 % of patients became completely continent . A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale ( 60.8 % vs 29.2 % , p < 0.001 ) . All other overactive bladder symptoms improved vs placebo ( p ≤ 0.05 ) . OnabotulinumtoxinA improved patient health related quality of life across multiple measures ( p < 0.001 ) . Uncomplicated urinary tract infection was the most common adverse event . A 5.4 % rate of urinary retention was observed . CONCLUSIONS OnabotulinumtoxinA 100 U showed significant , clinical ly relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated 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 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 Purpose : Overactive bladder affects 12 % to 17 % of the general population and almost a third experience urinary incontinence , which may severely impact health related quality of life . Oral anticholinergics are the mainstay of pharmacological treatment but they are limited by inadequate efficacy or side effects , leading to a high discontinuation rate . We report the results of the first large ( 557 patients ) , phase 3 , placebo controlled trial of onabotulinumtoxinA in patients with overactive bladder and urinary incontinence inadequately managed with anticholinergics . Material s and Methods : Eligible patients with overactive bladder , 3 or more urgency urinary incontinence episodes in 3 days and 8 or more micturitions per day were r and omized 1:1 to receive intradetrusor injection of onabotulinumtoxinA 100 U or placebo . Co‐ primary end points were the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients with a positive response on the treatment benefit scale at posttreatment week 12 . Secondary end points included other overactive bladder symptoms and health related quality of life . Adverse events were assessed . Results : OnabotulinumtoxinA significantly decreased the daily frequency of urinary incontinence episodes  vs placebo ( −2.65 vs −0.87 , p < 0.001 ) and 22.9 % vs 6.5 % of patients became completely continent . A larger proportion of onabotulinumtoxinA than placebo treated patients reported a positive response on the treatment benefit scale ( 60.8 % vs 29.2 % , p < 0.001 ) . All other overactive bladder symptoms improved vs placebo ( p ≤0.05 ) . OnabotulinumtoxinA improved patient health related quality of life across multiple measures ( p < 0.001 ) . Uncomplicated urinary tract infection was the most common adverse event . A 5.4 % rate of urinary retention was observed . Conclusions : OnabotulinumtoxinA 100 U showed significant , clinical ly relevant improvement in all overactive bladder symptoms and health related quality of life in patients inadequately treated with anticholinergics and was well tolerated OBJECTIVE To assess the objective efficacy of transcutaneous posterior tibial nerve stimulation in children presenting with overactive bladder resistant to well conducted treatment . MATERIAL AND METHOD This was a r and omized , double-blind , controlled study on 20 children with OAB . All patients were previously treated with anticholinergic drugs associated with detrusor rehabilitation , diet advice , bladder-voiding hygiene and constipation treatment , with poor clinical results . Patients were r and omized into two groups : -Group A : treatment with PTNS ( n = 11 ) . -Group B : sham treatment  ( n = 9 ) . The program lasted 12 consecutive weeks with two 30-minutes sessions a week . Each patient underwent pre-stimulation urodynamic testing to vali date bladder overactivity followed by a post-stimulation testing . Pre- and post-stimulation urodynamic parameters were compared in order to objective ly evaluate the treatment 's efficacy . The patients noted their incontinence episodes for 7 consecutive days in a diary before the beginning of the program , in the middle and at the end of it : this led to computing an incontinence score ( score ranged from 0 to 13 , from good to poor ) . The difference between the pre-stimulation and post-stimulation score enabled to express clinical results in terms of poor ( less than a 3-point decrease ) , medium ( a 3 to 5-point decrease ) , good ( 6 to 8-point decrease ) , very good ( final score ranged between 0 and 3 ) . Children were question ed regarding their impression of being stimulated or not . RESULTS In Group A , there were five very good clinical results ( 45 % ) , one medium ( 10 % ) and five poor results ( 45 % ) . In group B , nine very good results ( 66 % ) and three poor results ( 33 % ) were noted . Regarding urodynamic testing , volume voided during urgency ( 184 mL to 265 mL ) , maximal cystomanometry volume ( 215 mL to 274 mL ) and volume at the onset of the first overactive detrusor contraction ( ODC ) ( 48 mL to 174 mL ) were significantly increased in Group A ( p = 0.002 , p = 0.024 and p = 0.001 ) and maximal bladder pressure during ODC had decreased ( 61 to 46 ) ( p = 0.042 ) . 85 % children in group A thought they were being stimulated vs. 70 % in group B. CONCLUSION Even though we noticed urodynamics improvements in group A , which objective ly supports the efficacy of TCTPNS , clinical results remained the same between the two groups . In spite of the small size of our sample , this underlines the placebo effect of any type management in this pediatric population . Study ing precisely the maximal useful voltage and duration of stimulation should then be relevant in order to yield maximal benefits from this easy-to-use procedure Objective To verify whether the combination of transcutaneous electrical neural stimulation ( TENS ) with oxybutynin in the treatment of women with overactive bladder ( OAB ) would be more effective than isolated treatments . Methods We r and omized 75 women with OAB , in three groups : GI—30 min TENS , twice a week ; GII — daily slow release 10 mg oxybutynin ; and GIII — TENS + oxybutynin ( multimodal ) ; all for 12 weeks . Patients were evaluated with vali date d question naires International Consultation on Incontinence-Short Form ( ICIQ-SF ) , International Consultation on Incontinence-OAB ( ICIQ-OAB ) , Symptom bother , and 3-day Voiding diary at weeks 0 , 12 , and 24 . Results The groups were similar before treatment . After treatment , all groups significantly improved in OAB symptoms and quality of life ( QoL ) . At week 12 , ICIQ-OAB scores were 5.9 , 4.6 , and 2.9 , in groups I , II , and III , respectively , p = 0.01 . At week 24 , GI and GIII kept the scores of the end of treatment ( week 12 ) , while GII increased ICIQ-OAB from 4.6 to 9.2 , p = 0.0001 , ICIQ-SF from 9.8 to 13.3 , p = 0.0006 , and Symptom bother score from 3.4 to 7.0 , p = 0.0001 . Conclusions The multimodal treatment was more effective and TENS alone or in association presented longer lasting results for improvement of clinical symptoms of OAB and UNLABELLED The aim of this study was to evaluate the efficacy of the Posterior Tibial Nerve stimulation in women with overactivity bladder symptoms and the impact in the quality of life using the Overactivity Bladder Question naire ( OABq ) . METHODS thirty seven women from female urology outpatient clinic of the Hospital das Clinicas de Campinas ( HC/UNICAMP ) were enrolled in this prospect i ve , controlled and r and omized clinical trial . The patients were r and omly placed in one of two groups : TREATMENT GROUP : patients were su bmi tted to tibial posterior nerve electrical stimulation ( n=21 ) and Sham group : patients had electrodes placed without electricity ( n = 16 ) . After informed consent the patients underwent a physiotherapeutic evaluation , that included voiding diary and the overactivity bladder question naire ( OABq ) . The treatment schedule included eight sessions of electrical stimulation in the posterior tibial nerve , twice a week . RESULTS there were significant changes in symptoms such as frequency and nocturia ( p=0,003 and p=0,001 ) . The urgency and quality of life was improved in both group after treatment . CONCLUSION The posterior tibial nerve electrical stimulation is an effective treatment in overactive bladder PURPOSE Treatment options for patients with overactive bladder refractory to anticholinergics are limited . We assessed the dose response across a range of doses of onabotulinumtoxinA ( BOTOX ® ) in patients with idiopathic overactive bladder and urinary urgency incontinence whose symptoms were not adequately managed with anticholinergics .  MATERIAL S AND METHODS In a phase 2 , multicenter , r and omized , double-blind study , 313 patients with idiopathic overactive bladder and urinary urgency incontinence experiencing 8 or more urinary urgency incontinence episodes a week and 8 or more micturitions daily at baseline received 50 , 100 , 150 , 200 or 300 U intradetrusor onabotulinumtoxinA , or placebo . Symptoms were recorded using a 7-day bladder diary . The primary efficacy variable was weekly urinary urgency incontinence episodes and the primary end point was week 12 . RESULTS Demographics and baseline characteristics were balanced across the treatment groups . Durable efficacy was observed for all onabotulinumtoxinA dose groups of 100 U or greater for primary and secondary efficacy measures , including the proportion of incontinence-free patients . When the dose response curves were analyzed , doses greater than 150 U contributed minimal additional or clinical ly relevant improvement in symptoms . This finding was also reflected in health related quality of life assessment s. Dose dependent changes in post-void residual urine volume were observed and the use of clean intermittent catheterization was also dose dependent . The only adverse events significantly greater with onabotulinumtoxinA than with placebo were urinary tract infection and urinary retention . CONCLUSIONS OnabotulinumtoxinA at doses of 100 U or greater demonstrated durable efficacy in the management of idiopathic overactive bladder and urinary urgency incontinence . A dose of 100 U may be the dose that appropriately balances the symptom benefits with the post-void residual urine volume related safety profile
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 .