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Updated: Apr 11, 2026
Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity
Published on: January 10, 2013
The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum
Andrea Tubaro1, Federica Puccini, Cosimo De Nunzio
1Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Sapienza University of Rome, Italy.
Purpose Of Review:
We have reviewed the evidence published on botulinum toxin A (BoNT/A), percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS) in the management of overactive bladder (OAB).
Recent Findings:
BoNT/A is effective irrespectively of the number of previous anticholinergic treatments and of the reason for failure. Doses up to 360U 3-monthly are well tolerated. BoNT/A is well tolerated and effective also in the pediatric population. Bladder instillation of liposome encapsulated BoNT/A is a new approach, deserving further research. When using PTNS, motor response from the electrical stimulus is not required, a sensory response suffices. PTNS has a lasting effect compared to oxybutynin alone. SNS is superior to standard medical treatment but the combination of SNS and anticholinergics is more effective than anticholinergic alone.
Summary:
The evidence published in the last 18 months has increased the level of evidence on safety and effectiveness of BoNT/A, PTNS, and SNS in the management of OAB. BoNT/A is now recommended as standard third-line treatment for OAB (in the USA) and urgency incontinence (in the USA and in Europe) in selected patients refractory to pharmacological therapy. All available third-line treatment options for OAB/urgency urinary incontinence should be offered before surgery is contemplated.
Video Abstract:
http://links.lww.com/COU/A7.
