1. To assess the efficacy of Transcutaneous posterior tibial nerve stimulation(TTNS) in women with refractory Overactive bladder (OAB)

2. To see if there are any adverse effects with TTNS

Design: Prospective study.

n=30

Duration: 6months (October 2024 to March 2025, including the follow up)

Inclusion criteria:  Non-pregnant women 18-70 years, diagnosed with Overactive bladder (OAB), not responding to 8 weeks of behavioural therapy or 4 weeks of antimuscarinic medication, were recruited for the study.

Exclusion criteria: Women who had pelvic surgery in the 3 months before the commencement of the study, diagnosed with neurogenic OAB or having a co-existing neurological condition, prolapse stage 2 or more, concomitant fecal incontinence, are unable to perform Kegel's exercises, having implants or skin damage at the stimulation site were excluded.

Evaluation: The socio-demographic characteristics of the patients and the duration of symptoms were recorded. 

A 3 day voiding diary was noted and the outcome measures (ICIQ-OAB, ICIQ-OAB-QOL and ICIQ-FLUTSSex) were recorded at the baseline(before TTNS) and at the end of 8 weeks therapy and 3 months later.

Procedure: The posterior tibial nerve was stimulated through two surface electrodes placed on one leg, along its path. 
One electrode (live pad) was placed 5cm posterior and superior to the medial malleolus and the other (ground pad) approximately 10 cm cephalic to the first one.
TENS machine was used for stimulation for 30 min in each session with a pulse width of 200 microseconds and a frequency of 10Hz. The amplitude intensity was increased gradually and set just below the discomfort level of the patient.

The stimulation sessions were done twice a week for 8 weeks, under expert supervision.

The total number of pelvic floor muscle exercises was increased from a minimum of 3 sessions with 10 repetitions/day to a maximum of 6 sessions with 10 repetitions/day over 8 weeks. 
The bladder training was applied to all individuals.

Global response assessment (GRA) was done at the end of 8 weeks treatment and at 3 months.

4 patients were lost for follow up.

The statistical analysis was done for 26 patients using Paired t-test on the said scores, pre and post TTNS.

Significant improvements were observed across all outcome measures:

OAB Symptom Score reduced by a mean of 33.3 points (SD = 5.0)
Quality of Life (QoL) improved by 80.1 points (SD = 8.4)
FLUTSSex Score (urinary symptoms affecting the sexual function) decreased by 22.2 points (SD = 4.7)

These changes indicate consistent symptomatic and quality-of-life improvement following TTNS therapy.

The improvement continued to be the same at 3 months follow up.

The mean of GRA was 4.75 at 8 weeks and remained the same at 3 months follow up.

No adverse effects were noted in the duration of treatment and follow up.

TTNS therapy resulted in substantial reductions in overactive bladder symptoms and urinary distress, along with a significant enhancement in QoL. The consistency of improvement across all three scales, with relatively low standard deviations, highlights the therapeutic reliability and efficacy of TTNS in this population, addressing the different dimensions of OAB.
 
Longer follow up with larger numbers and multi centre randomised controlled trials would be required for further validation of TTNS as a therapeutic approach for OAB.

Shortcomings in this study are small sample size, non-randomisation and shorter follow up.

TTNS is an effective non-invasive treatment option for patients with refractory OAB. 

It significantly improves both urinary symptom burden and quality of life. These findings support the wider adoption of TTNS as a safe, outpatient-based neuromodulation therapy. 

TTNS can be self administered by patients at home.

Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial  Author links open overlay panel Rafet Sonmez ,  Necmettin Yildiz ,  Hakan Alkan Pamukkale University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, 20100 Kinikli, Denizli, Turkey; Annals of Physical and Rehabilitation Medicine Volume 65, Issue 1, January 2022, 101486
A single-blind, randomized controlled trial to evaluate the effectiveness of  TTNS in Overactive Bladder symptoms in women responders to percutaneous tibial nerve stimulation (PTNS) Miguel Martin-Garcia a,*, Jennifer Crampton b a Physiotherapy Department, Liverpool Women’s NHS Trust, Crown Street, Liverpool, L8 7SS, UK b Department of Health Professions, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, Manchester, M15 6GX, UK; Physiotherapy 105 (2019) 469-475
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. Annals of Physical and Rehabilitation Medicine. 2022 Jan;65(1):101486.