Introduction
Overactive bladder syndrome (OAB) is a symptomatic diagnosis consisting
of urinary frequency, urgency and nocturia, with or without urge urinary
incontinence (1). Lifestyle changes and behavioral therapy are
recommended as the first-line treatment in OAB. Anticholinergics, which
are second-line treatment modalities, are recommended for patients who
do not respond to behavioral therapy. In patients who do not respond to
medical treatment, posterior tibial nerve stimulation (PTNS), botulinum
toxin injection, sacral neuromodulation, and pelvic floor rehabilitation
are used as the third step treatment method (2).
In the literature, PTNS, one of these 3rd step treatment methods, has
been observed to improve symptoms over 50% in refractory OAB (3, 4).
PTNS can be applied percutaneously with a needle electrode or
transdermally with an adhesive surface electrode. This method is very
advantageous because it is not invasive, it can be performed easily, the
patient feels less pain, is cheaper, and no side effects (5). Besides,
transcutaneous tibial nerve stimulation (TTNS) can be performed by the
patient in the home environment by providing the necessary training.
Along with these advantages, it has been reported that its efficacy is
similar to PTNS in the literature (6, 7). The TTNS protocol is generally
performed as weekly 30-minute sessions for 12 weeks. (8). However, there
are different protocols in the literature regarding the frequency of
TTNS treatment. (9, 10, 11, 12).
There is only one study comparing the number of PTNS sessions in
resistant OAB treatment (13). However, there is no comparative study on
the number of TTNS sessions in refractory OAB. There is a study
comparing the effectiveness of the number of sessions of TTNS only in
fecal incontinence (14). Based on this evidence, we aimed to find the
ideal frequency of the TTNS procedure in the treatment of refractory OAB
in women.