Overactive bladder (OAB) significantly impacts quality of life, with management strategies including neuromodulation, anticholinergics, β3 agonists, and intradetrusor onabotulinumtoxinA (Botox). Transcutaneous tibial nerve stimulation (TTNS) is gaining attention as an adjunct to pharmacologic therapy. This study evaluated the efficacy and safety of TTNS alone and in combination with medications.

We retrospectively analysed 35 OAB patients treated between 2021 and 2023, categorised into four groups: (1) TTNS alone (n=9), (2) TTNS + anticholinergics (n=9), (3) TTNS + β3 agonists (n=9), and (4) Botox (n=8). The Overactive Bladder Symptom Score (OABSS) and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were assessed at baseline, 8 weeks, and 6 months. Adverse effects were also recorded.

At 8 weeks, all groups demonstrated symptom improvement. The mean OABSS reduction was greatest in the Botox group (n=8; -4.2 points), followed by TTNS + β3 agonists (n=9; -3.5), TTNS + anticholinergics (n=9; -3.3), and TTNS alone (n=9; -2.8). ICIQ-UI SF scores improved similarly, with the greatest reduction in the Botox group (n=8; -5.1 points). At 6 months, these trends persisted, with Botox showing the most sustained symptom relief (n=8; OABSS: -6.1). TTNS combined with medications demonstrated superior efficacy compared to TTNS alone. Regarding adverse effects, TTNS alone was well tolerated. The TTNS + anticholinergic group experienced dry mouth (n=4) and constipation (n=2). The TTNS + β3 agonist group had hypertension (n=1). Botox was associated with urinary retention (n=3), which required temporary catheterization in two patients.

TTNS enhances pharmacologic therapy effectiveness in OAB management. While Botox offers the most significant symptom relief, it carries a higher risk of urinary retention. These findings support TTNS as a viable adjunctive therapy for OAB.