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The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder.

Methods

A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms—frequency, nocturia, and urgency—and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement.

Results

Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12–2.38, n = 73). On the pooled analysis, the different neurostimulation protocols—intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation—demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week.

Conclusions

There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.

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Abbreviations

OAB:

Overactive bladder

QoL:

Quality of life

ICIQ-OAB:

International Consultation on Incontinence Questionnaire Overactive Bladder

I-QOL:

Incontinence Quality of Life Instrument

OAB-q SF:

Overactive Bladder Questionnaire Short Form

MD:

Mean difference

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Acknowledgements

The authors thank Prof. Marcos de Noronha from LaTrobe University for supporting the meta-analysis process.

Author information

Authors and Affiliations

  1. Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil

    Kamilla Zomkowski

  2. Physical Therapy Department, Universidade do Estado de Santa Catarina, Florianópolis, SC, Brazil

    Ingridy Kammers, Bruna Baungarten Hugen Back, Géssica Maria Moreira, Anelise Sonza & Fabiana Flores Sperandio

  3. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Carrera de Kinesiología, Santiago de Chile, Chile

    Cinara Sacomori

  4. Universidad Bernardo O’Higgins, Santiago de Chile, Chile

    Cinara Sacomori

Authors
  1. Kamilla Zomkowski
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  2. Ingridy Kammers
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  3. Bruna Baungarten Hugen Back
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  4. Géssica Maria Moreira
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Contributions

K. Zomkowski: Protocol/project development; Data collection or management; Formal analysis; Methodology; Project administration; Manuscript writing/editing. I. Kammers: Data collection or management; Formal analysis; Methodology; Manuscript writing/editing. B. B. Hugen Back: Data collection or management; Formal analysis; Methodology; Manuscript writing/editing. G. M. Moreira: Validation; Visualization; Manuscript writing/editing. A. Sonza: Protocol/project development; Validation; Manuscript writing/editing. C. Sacomori: Protocol/project development; Methodology; Validation; Manuscript writing/editing. F. F. Sperandio: Protocol/project development; Methodology; Validation; Visualization; Manuscript writing/editing.

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Correspondence to Cinara Sacomori.

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Zomkowski, K., Kammers, I., Back, B.B.H. et al. The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis. Int Urogynecol J 33, 1045–1058 (2022). https://doi.org/10.1007/s00192-022-05088-7

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