Overactive bladder (OAB) syndrome significantly affects an individual's quality of life, causing anxiety, discomfort, and embarrassment.
Approximately 20.8% of the Asian population is affected by detrusor overactivity , the main cause of overactive bladder syndrome in women. In Hong Kong, the prevalence of OAB was reported to be 15.1%, affecting women more than men .(1)
The management of Overactive Bladder (OAB) involves various treatment options: Conservative management includes behavioral training, bladder re-education and pelvic floor exercises with low treatment efficacy on many patients. 
Anticholinergics being the first-line medical treatment is notorious with their side effects leading to high prescription threshold and poor drug adherence rates.
Percutaneous Tibial Nerve Stimulation (PTNS) is recommended for women who do not responded to antimuscarinic medications(2)
Electroacupuncture has emerged as a promising treatment option for Overactive Bladder  (OAB), with efficacy comparable to Percutaneous Tibial Nerve Stimulation (PTNS). Meta-analyses(3) indicate that the effect of electroacupuncture is on par with medications . It reduces the episodes of micturition over a 24-hour period, increases the voided volume, and lowers the overall OAB symptom scores .

Aim of study
To evaluate the effectiveness of percutaneous tibial nerve stimulation by electroacupuncture technique on female overactive bladder patients

It is a retrospective cohort study. Female patients with OAB who were refractory to first-line conservative and medical treatment would be referred for a urodynamic study (UDS). Patients with detrusor overactivity diagnosed on UDS would be referred for physiotherapy management by urogynaecologists. 
Physiotherapy management included continence counselling sessions where patients received an educational talk, bladder training and one-to-one pelvic floor exercises education. It followed by 12 weekly treatment sessions of PTNS via electroacupuncture. Electroacupuncture involved inserting a needle  into the Sanyinjiao (SP6) acupoint , located above  the medial malleolus, and applying electrical current  through the needle, with a pad electrode completing the circuit on the foot's mid-arch of the left leg.(Fig .1 )
Continence physiotherapists recorded the following outcome measures via bladder chart and Overactive bladder symptom score questionnaire (OABSS) before the commencement of PTNS by electroacupuncture and upon completion of the 12 weekly sessions.
• Frequency of incontinence (per week)
• Daytime Urinary frequency (per day)
• Frequency of nocturia (per day)
• Minimum voiding volume (milliliter)
• Maximum voiding volume (milliliter)
• OABSS Overactive bladder symptom score (3-5 mild, 6-11 moderate, 12 or above severe)

A total of 18 patients completed the program with 3 months of electroacupuncture treatment sessions. Results indicated significant improvements across all outcome measures including, reduced daytime voiding frequency from 10 to 7.7 (P<0.003), increased maximum voiding volume from 258ml to 316ml (p<0.028) and minimum voiding volume from 76ml to 108ml (p<0.028), reduced nocturia episodes from 3 to 1.5 (p<0.001) and incontinence episodes from 20.5 / week to 8.5 / week (p<0.002). The OABSS score reduced from 9.94 to 7.44 (P<0.001).(Fig. 2). The data was analyzed statistically via Pair-t test and Wilcoxon Signed Ranks Test in SPSS Statistics .

PTNS by electroacupuncture technique improved OAB symptoms in female population as reflected in the improvement in frequency of incontinence, urinary frequency, nocturia frequency, minimum voiding volume,  maximum voiding volume and OABSS score.

Our pilot study shows that PTNS by electroacupuncture technique is an effective treatment for refractory OAB female patients. It is of particular relevance in Physiotherapy departments where electroacupuncture is used in a wide range clinical scenario. Performing effective PTNS would no longer require a designated machine and equipment. Although our experience with electroacupuncture has been promising, further investigations with a larger sample size are necessary to explore its long-term effects and allow comprehensive analysis.

Yee CH, Chan CK, Teoh JY, et al. Survey on prevalence of lower urinary tract symptoms in an Asian population. Hong Kong Med J 2019;25:13-20.
Sonmez, R.; Yildiz, N.; Alkan, H. Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial. Ann. Phys. Rehabil. Med. 2022, 65, 101486.
Mak TC, Chen HY and Cho WC. Acupuncture for overactive bladder in adults: a systematic review and meta-analysis. Acupuncture in Medicine 2019, Vol. 37(6) 321–331.