Transcutaneous tibial nerve stimulation (TTNS), if available and affordable, can be an equivalent alternative for pharmacological therapy in multiple sclerosis (MS) patients with neurogenic bladder. Current study aimed to compare the clinical outcomes, and quality of life between TTNS and pharmacological treatments in MS patients with neurogenic bladder.

We conducted a controlled clinical trial between February 2024 and January 2025. We included women above 18 years old, with MS, and at least one lower urinary tract symptoms (LUTS) such as frequency, urgency, nocturia, and urinary incontinence, without incomplete emptying. Neurogenic detrusor overactivity (NDO) was confirmed by the presence of involuntary detrusor contraction in standard cystometry. We divided the patients into two groups using block randomization to balance participants in each group. The intervention group was treated with TTNS and the control group was treated with solifenacin (5 or 10 mg per day depending on the severity of symptoms) for 3 months.
For the intervention group, we used electrical stimulator to send signals through electrodes placed on the skin. A negative electrode was placed behind the internal malleolus, and a positive electrode was placed 10 cm above it in the direction of the tibial nerve. We used 10 Hz frequency and 200 milliseconds pulse width. The intensity was 1.5 times the muscle twitch threshold. Patients had 30-minute sessions every week for 12 weeks. 
All patients completed the international consultation on incontinence questionnaire overactive bladder (ICIQ-OAB) and incontinence quality of life (I-QOL) questionnaires before receiving the treatment and 3 months later.

We included 26 patients in the intervention group (TTNS) and 26 patients in the control group (pharmacological treatment). Three patients could not complete TTNS and were excluded from the study. The differences of demographic characteristics of the two groups were not noticeable. 
According to the results of the ICIQ-OAB questionnaire, the intervention group experienced improvements in night-time urinary frequency (p = 0.013), urgency (p = 0.021), and leakage (p = 0.018). The total ICIQ-OAB score had a greater reduction in the intervention group (p = 0.015), but the daytime urinary frequency did not show a significant difference (p = 0.532). The intervention group showed significant improvements in I-QOL scores compared to the control group, especially in the psychosocial impact (PSI) (p = 0.022) and social embarrassment (SE) (p = 0.018) aspects. While both groups made noticeable progress in reducing avoidance and limiting behavior (p < 0.05), the difference was not statistically significant (p = 0.091).

According to our results, transcutaneous tibial nerve stimulation (TTNS) is an effective treatment for reducing overactive bladder (OAB) symptoms and improving quality of life in MS patients. Although TTNS and pharmacological treatment showed improvements in urinary symptoms, the TTNS group had better outcomes in reducing night-time urinary frequency, urgency, and leakage. Furthermore, the intervention group showed notable improvements in psychological and social aspects of quality of life. 
Our findings show that TTNS can be as effective as anticholinergic treatment without significant side effects and can be considered as a promising alternative to pharmacological treatments if it is available and cost-effective in a society. In addition, TTNS is a suitable treatment for patients who cannot tolerate the side effects of pharmacological treatments.

In conclusion, TTNS appears to be a reliable treatment for managing OAB symptoms in MS patients with neurogenic bladder and it can be used as an alternative for pharmacological treatment. Additionally, TTNS is able to enhance the patients’ quality of life without the common side effects of the anticholinergics.