Neurostimulation for overactive bladder (OAB) in women

Neurostimulation for overactive bladder (OAB)

Neurostimulation covers transcutaneous sacral nerve stimulation (surface electrodes placed above the sacrum), transcutaneous posterior tibial nerve stimulation (surface electrodes place above the posterior tibial nerve) and percutaneous posterior tibial nerve stimulation (needles inserted close to the posterior tibial nerve).

• transcutaneous sacral nerve stimulation
  • transcutaneous sacral nerve stimulation should not be offered to treat OAB in women
    
    
• transcutaneous posterior tibial nerve stimulation
  • there is insufficient evidence to recommend the use of transcutaneous posterior tibial nerve stimulation to treat OAB
  • transcutaneous posterior tibial nerve stimulation should not be offered for OAB
    
    
• percutaneous posterior tibial nerve stimulation
  • do not offer percutaneous posterior tibial nerve stimulation for OAB unless:
    • there has been a multidisciplinary team (MDT) review, and
    • conservative management including OAB drug treatment has not worked adequately, and
    • the woman does not want botulinum toxin A or percutaneous sacral nerve stimulation
  • explain that there is insufficient evidence to recommend the use of percutaneous posterior tibial nerve stimulation to routinely treat OAB
    
    
• percutaneous sacral nerve stimulation
  • percutaneous sacral nerve stimulation to should be offered women only after MDT review if:
    • their OAB has not responded to conservative management including drugs, and
    • they are unable to perform clean intermittent catheterisation
  • consider percutaneous sacral nerve stimulation after MDT review if a woman's OAB symptoms have not responded to botulinum toxin type A or they are not prepared to accept the risks of needing catheterisation associated with botulinum toxin type A.
  • discuss the long-term implications of percutaneous sacral nerve stimulation with women including:
    • the need for test stimulation and probability of the test's success
    • the risk of failure
    • the long-term commitment
    • the need for surgical revision
    • the adverse effects

Reference:

• 1) NICE (April 2019). Urinary incontinence: The management of urinary incontinence in women