Overactive bladder (OAB) is associated with aberrant supraspinal network activity involving the supplementary motor area (SMA) and dorsolateral prefrontal cortex (dlPFC). Current OAB therapies primarily target peripheral pathways. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation therapy that can induce neuroplastic changes by altering cortical excitability. We hypothesized that a combined protocol of inhibitory low-frequency (LF) rTMS to the SMA and excitatory high-frequency (HF) rTMS to the dlPFC would be feasible, safe, and associated with improvements in OAB symptom burden.

This was a prospective, single-arm pilot trial of adults with idiopathic OAB. Inclusion criteria included ≥8 voids and ≥3 urgency episodes per 24 hours on bladder diary. Participants completed five daily 40-minute neuronavigated rTMS sessions targeting bilateral pelvic SMA (1 Hz) and right dlPFC (10 Hz). Clinical outcomes were measured using validated patient-reported outcome measures (Overactive Bladder Questionnaire Short Form (OAB-qSF), Lower Urinary Tract Symptoms Network Symptom Index-10 (LURN SI-10), Patient Perception of Bladder Condition (PPBC) and Hospital Anxiety and Depression Scale (HADS)) and bladder function parameters were derived from standardized 2-day bladder diaries. Outcomes were assessed at baseline, immediately post-treatment, and at 3-week and 6-week follow-up intervals. Linear mixed models evaluated longitudinal changes from baseline.

Fourteen participants (13 female) with a mean age of 67 years completed the intervention. rTMS was well tolerated with no serious adverse events. Minor transient adverse effects (headache and facial muscle twitching) were reported in 71% of participants. Significant improvements (p<0.05) were observed across all follow-up intervals in the OAB-qSF symptom bother score (SBS) and health-related quality of life (HRQOL) subscales, and LURNSI-10 (Table 1). Reductions in bladder diary measures per 24 hours including urinary incontinence (UI) episodes, pads used, voids and urgency episodes were also noted. Changes in anxiety and depression scores (HADS) were not significant.

The significant and sustained clinical improvements across multiple validated scales suggest that rTMS effectively reduces OAB symptom burden. The reduction in both subjective bother and objective diary events, such as urgency episodes and pad use, indicates that targeting the SMA and dlPFC provides a meaningful therapeutic effect. The durability of these clinical improvements through the 6-week mark suggests potential for lasting benefit beyond the immediate treatment period.

This pilot trial demonstrates that neuronavigated rTMS is a safe and potentially effective non-invasive therapy for idiopathic OAB. These findings support further investigation of supraspinal neuromodulation as a novel therapeutic approach for OAB. Larger randomized sham-controlled trials are needed to confirm efficacy and durability.

Continence 19S (2026) 102678
DOI: 10.1016/j.cont.2026.102678