Comparing electrical stimulation to other therapies for the treatment of overactive bladder

This study compared the effects of non-implanted electrical stimulation (ES) to muscle training or drug therapy for overactive bladder (OAB). The authors concluded that ES may be better than muscle training or drug therapy for improving OAB symptoms.

A common symptom of overactive bladder (OAB) is urinary incontinence (leaking urine) either with  or without urges. OAB has a significant effect on a person’s quality of life and overall well-being, as it can interrupt sleep and social activities.

Treatment for OAB includes bladder or pelvic muscle training, drug therapy, and electrical stimulation (ES). ES targets the nerves controlling the pelvic floor, a group of muscles that support the bladder. ES can be delivered with electrodes placed under the skin (percutaneous stimulation), in the vagina or anus, or on the surface of the skin (transcutaneous stimulation). Whether non-implanted ES achieves better outcomes than other therapies remains under investigation.

This study analyzed the results of 63 studies that compared electrical stimulation (ES) to placebo, sham (inactive treatment), or common OAB therapies. These included pelvic muscle training, drug treatments, and combinations of ES with PMT or drugs. Drug treatments included tolterodine (Detrol), oxybutynin (Ditropan), and propantheline bromide (Pro-Banthine). These studies involved 4424 patients with OAB. The average follow-up period ranged from 1 month to 2 years.

Compared to placebo or sham treatment, participants who received ES were 2.26 times more likely to report cure or improvement of OAB symptoms. Percutaneous stimulation (of the tibial nerve; PTNS) was 3.19 times more effective. Intravaginal stimulation (in the vagina) was 5.46 times more effective. ES reduced the average number of daily incontinence episodes (by 1.43), nighttime urination (nocturia; by 0.37), and daily urination (by 1.09). Available data was insufficient to determine whether ES had fewer side effects.

Compared to pelvic muscle training, participants who received ES were 60% more likely to report cure or improvement of OAB symptoms. No difference was found between ES and pelvic muscle training in improving incontinence episodes, daily urination, or nocturia.

Compared to PMT alone, participants who received ES plus pelvic muscle training were 2.82 times more likely to report improvements in urge urinary incontinence. ES plus PMT reduced the average number of daily incontinence (by 0.83) and urgency episodes (by 2.49).

Compared to all drug treatments, participants who received ES were 20% more likely to report cure or improvement of OAB symptoms. No difference was found between ES and individual drugs, and there was no difference in reported OAB cure.

Intravaginal stimulation was 28% more effective than drug treatment. PTNS was not significantly more effective than drug treatment. ES reduced the average number of daily incontinence episodes by 0.24 compared to drug therapy. ES was associated with decreased risk of side effects compared to tolterodine (88%) and oxybutynin (89%).

Compared to drug treatment alone, ES plus tolterodine or estrogen cream decreased the average number of incontinence episodes (by 0.53) and urgency episodes (by 2.49). No difference was found for daily urination episodes.

The authors concluded that ES may be better than muscle training or drug therapy for improving OAB symptoms, and that adding ES to other treatments may be beneficial. 

The authors reported insufficient data for some comparisons between ES and the OAB therapies in the analyzed studies. The authors also reported insufficient data to determine if one type of ES was more effective than another. More studies are needed to confirm these results, and further investigate outcomes and side effects.