Overactive bladder (OAB) is a highly prevalent condition associated with significant impairment in quality of life, with urgency and urgency urinary incontinence representing the most bothersome symptoms. Peripheral neuromodulation techniques, including percutaneous tibial nerve stimulation (PTNS) and transcutaneous tibial nerve stimulation (TTNS), are established third-line therapies supported by a robust evidence base. However, their real-world effectiveness remains constrained by treatment burden, the need for repeated clinic-based sessions, and suboptimal long-term adherence.
Peroneal neuromodulation has recently emerged as a novel approach targeting similar lumbosacral neural pathways, with the potential to overcome key limitations of existing strategies.
This study aims to evaluate whether peroneal neuromodulation represents a clinically meaningful evolution in peripheral neuromodulation for OAB.

A structured narrative review was conducted using MEDLINE and Embase databases to identify studies evaluating peroneal neuromodulation in patients with OAB. Clinical, mechanistic, and comparative studies were included.
Evidence relating to PTNS and TTNS was analysed for contextual comparison, particularly regarding efficacy, durability, and treatment delivery models.
Given heterogeneity in study design, stimulation protocols, and reported outcomes, a qualitative synthesis was performed. The analysis was structured around three domains: mechanistic plausibility, clinical effectiveness and safety, and translational potential, including feasibility, accessibility, and scalability.

Peroneal neuromodulation demonstrates strong physiological plausibility, supported by shared lumbosacral innervation (L4–S3) and emerging functional neuroimaging evidence indicating modulation of central networks involved in bladder control.
Early clinical studies report consistent improvements across core OAB outcomes, including urinary frequency, urgency, urgency urinary incontinence, and patient-reported quality of life. Tolerability profiles are favourable, with minimal adverse effects and high patient acceptability.
A key differentiating feature is anatomical accessibility, allowing simplified and reproducible electrode placement. This facilitates the development of flexible treatment paradigms, including transcutaneous and home-based delivery systems, with the potential to reduce healthcare utilisation and improve adherence.
In contrast, PTNS and TTNS are supported by randomised controlled trials and long-term outcome data, reflecting a mature stage of clinical development. However, their dependence on structured, clinic-based treatment protocols may limit scalability and contribute to attrition over time.
Current evidence for peroneal neuromodulation remains limited by small sample sizes, short follow-up, heterogeneity in stimulation parameters, and absence of direct comparative trials.

Peroneal neuromodulation integrates mechanistic plausibility with practical advantages in treatment delivery, directly addressing key limitations of existing peripheral neuromodulation strategies.
By enabling simplified, potentially decentralised and patient-driven therapy, it introduces a shift from clinic-dependent models towards scalable neuromodulation approaches.
While the evidence base remains early-phase, the consistency of clinical signals, combined with favourable tolerability and feasibility, suggests potential to enhance real-world effectiveness through improved accessibility and adherence.

Peroneal neuromodulation is a promising emerging therapy for OAB that may represent a clinically meaningful evolution in peripheral neuromodulation.
By addressing key limitations of established approaches, particularly treatment burden and scalability, it has the potential to redefine how neuromodulation is delivered in routine practice.
High-quality comparative studies are required to determine its relative efficacy, durability, and optimal positioning within the therapeutic pathway.