Overactive Bladder Syndrome (OAB), as defined by the International Continence Society (ICS), is urinary urgency, usually accompanied by urinary frequency and nocturia, with or without urgency urinary incontinence, in the absence of infection or other obvious pathology. OAB significantly impacts quality of life (QOL), productivity, and finances. Traditional pharmacological treatments often present limited tolerability and efficacy, leading to discontinuation by many patients. Transcutaneous Tibial Nerve Stimulation (TTNS), a non-invasive neuromodulatory intervention, has emerged as a promising alternative for managing idiopathic OAB, but optimal treatment protocols remain undefined. This systematic review aims to evaluate the effectiveness of TTNS, with a focus on treatment frequency and duration.

A systematic review was conducted, searching six databases—PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, and CINAHL—for studies published within the last five years. The inclusion criteria focused on English-language studies evaluating TTNS alone or compared with other treatments for idiopathic OAB in adults. Exclusions included studies on pediatric populations or OAB due to neurogenic causes. A total of 258 records were screened, resulting in the inclusion of 12 studies. Data extraction and quality assessment followed the Critical Appraisal Skills Programme (CASP) and Cochrane bias assessment standards.

Analysis confirmed that TTNS is a safe, effective, and well-tolerated intervention for idiopathic OAB, with reported symptom improvement in 35–94% of patients. Studies showed non-inferiority of TTNS compared to pharmacological therapies, with notable advantages in cost-effectiveness, safety, and suitability for high-risk populations. However, wide heterogeneity in TTNS protocols (frequency/duration) and outcome measure tools across studies highlighted the absence of standardised treatment guidelines. Long-term efficacy beyond 12 months remains unclear, with some studies documenting a decline in symptom improvement after one year.

TTNS shows promise as a non-invasive, effective therapy for managing idiopathic OAB. Its potential for earlier inclusion in the OAB treatment algorithm is supported by its safety, cost-effectiveness, and ability to address a treatment gap for patients intolerant to pharmacotherapy or invasive procedures. However, further research is required to standardise treatment protocols, establish long-term efficacy, and better understand its cost-effectiveness to inform clinical practice fully.