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.