Anticholinergic Burden in Patients Treated for Overactive Bladder: Second-Line Therapy with Tibial Nerve Stimulation as a Solution.

Overactive bladder (OAB) is a highly prevalent condition with significant associated comorbidities. Current management guidelines suggest the utilization of anticholinergic medication as a second line after nonpharmacological treatment. Tibial nerve stimulation (TNS), which has previously been thought to have been expensive and inaccessible, was relegated to a third-line therapy. However, given the recently discovered association between anticholinergic medication use and dementia as well as the recent FDA approval of transcutaneous tibial nerve stimulation (TTNS), there may be a need to revisit management guidelines. In this commentary, we identify the two types of TNS, percutaneous tibial nerve stimulation (PTNS) and TTNS and compare them with anticholinergics. By considering their respective efficacies, side-effects profiles, and associated costs, we make the case in this commentary for an update to guidelines that includes TNS as second-line OAB management ahead of anticholinergic medication.

International urogynecology journal. 2024 May 03 [Epub ahead of print]

Nihal Satyadev, Maryam Ameen, Trieu H Do, Hsin Wang

Department of Neurology, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, 3224, USA. ., Department of Medicine, Ross University, Bridgeton, Barbados, USA., Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA., Department of Obstetrics and Gynecology, Detroit Medical Center, Bloomfield Hills, MI, USA.