Overactive bladder (OAB) is a debilitating condition that significantly impacts quality of life. Transcutaneous tibial nerve stimulation (TTNS) offers a low-cost, non-surgical treatment by providing neuromodulation to the sacral plexus via the tibial nerve, modulating bladder activity. While standard treatment regimens of TTNS (one session per week, 30 minutes per session for 12 weeks) show positive outcomes for pharmaceutically naïve patients, the same success rate is not observed in pharma-refractory cases. Emerging evidence suggests that increasing the frequency of treatment sessions may lead to enhanced outcomes in OAB management. This study investigates whether a high-frequency TTNS protocol improves clinical outcomes compared to standard regimens.

A prospective pilot study was conducted on 10 patients (5 males, 5 females), aged 20–75 years, with moderate to severe OAB symptoms (IPSS range 17–21). Patients underwent TTNS using a TENS machine, applying mild electrical pulses to the tibial nerve (active electrode behind the medial malleolus, earth electrode over the shin). Treatments were administered 4–7 times weekly (average 5 sessions per week) for 30 minutes each, over six weeks. Pre- and post-treatment outcomes were measured using the International Prostate Symptom Score (IPSS) and a quality of life (QOL) scale.

Of the 10 patients, 80% (n=8) showed significant symptom improvement. Average IPSS decreased by 68%, with mean scores improving from 19 to 11.7 (p<0.05), transitioning patients from severe to moderate OAB categories. Similarly, QOL scores improved by 71%, with a mean reduction from 5.5 (unhappy/terrible) to 1.6 (pleased/unhappy). Notable improvements were seen in urgency, frequency, nocturnal frequency, and overall quality of life. Two patients required further management, including sacral neuromodulation and investigation for nocturnal polyuria.

High-frequency TTNS demonstrates significant potential as an alternative protocol for OAB management, offering a low-risk, cost-effective solution with better patient outcomes than standard regimens. Although the small sample size limits generalizability, these promising results warrant larger-scale studies. Increasing TTNS frequency could transform OAB care, improving symptom control, enhancing quality of life, and offering hope for patients resistant to traditional therapies.