Neuromodulation techniques for managing overactive bladder

Overactive bladder (OAB) represents a significant burden and has a considerable impact on the quality of life (QoL) of affected patients. The treatment of this condition poses notable challenges due to its multifactorial pathophysiology and the frequent refractoriness to standard pharmacological therapies. In recent years, neuromodulation has gained increasing relevance as an effective and minimally invasive therapeutic strategy, offering promising results in selected patients. Among the currently available modalities, sacral neuromodulation is considered the gold standard, supported by long-term data demonstrating its efficacy, safety, and positive impact on QoL. Conversely, tibial nerve stimulation, characterized by its reduced invasiveness, is indicated as a second- or third-line treatment for OAB patients who have not responded to pharmacological therapies. More recently, other forms of neurostimulation, such as pudendal nerve or spinal cord stimulation, have attracted attention, although they remain in the experimental phase, with preliminary data suggesting potential benefits in highly selected populations. Despite the growing use of neuromodulation in urological practice, the choice of technique and the prediction of therapeutic response remain complex and not yet fully standardized. In this context, the application of artificial intelligence may offer new opportunities to support clinical decision-making, enabling more accurate patient selection, optimization of treatment outcomes, and a step toward precision medicine in the management of lower urinary tract dysfunctions.