Transcutaneous tibial neuromodulation, is the future of neuromodulation here?

Transcutaneous tibial nerve stimulation (TTNS) has emerged as an attractive treatment option for the management of overactive bladder (OAB) symptoms. This review summarizes the clinical and real-world evidence supporting the efficacy, safety, and patient-reported outcomes of TTNS in OAB.

A comprehensive search of the PubMed database was conducted in December 2025 using the keyword "transcutaneous tibial nerve stimulation." This search identified 623 records, which were screened by title for relevance to the objectives of this narrative review. All eligible articles were included.

A total of 28 prospective studies published between 2011 and 2025 met the inclusion criteria. Across prospective studies, TTNS was associated with improvements in urgency, frequency, and urgency urinary incontinence, with a mean responder rate of 72.2%, according to each study's outcome measures. Compared with sham, TTNS demonstrated significant benefit in studies including patients with non-neurogenic OAB. Evidence in neurogenic bladder disorders was limited and heterogeneous. TTNS was also found to be non-inferior to percutaneous tibial nerve stimulation in one randomized controlled trial (RCT). In comparisons with anticholinergics, TTNS was generally less effective in symptom reduction but markedly better tolerated.

TTNS is a safe, simple, patient-friendly and non-invasive neuromodulation option for lower urinary tract symptoms management. Improvement of symptoms is observed in over two third of cases, with minimal adverse events and excellent tolerability. Long term studies are warranted to further evaluate treatment persistence, as well as well-designed RCTs vs other treatment options to refine the role of TTNS in the therapeutic armamentarium.