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

• Published in: International Urogynecology Journal Vol. 35; no. 7; pp. 1375 - 1379
• Main Authors: Satyadev, Nihal, Ameen, Maryam, Do, Trieu H., Wang, Hsin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2024; Springer Nature B.V
• Subjects: Anticholinergics; Bladder; Cholinergic Antagonists - adverse effects; Cholinergic Antagonists - therapeutic use; Clinical Opinion; Clinical trials; Constipation; Costs; Dementia; FDA approval; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Nocturia; Obstetrics; Older people; Practice Guidelines as Topic; Side effects; Tibial Nerve; Transcutaneous Electric Nerve Stimulation; Urinary Bladder, Overactive - drug therapy; Urinary Bladder, Overactive - therapy; Urology; Nerve stimulation; Anticholinergics; Overactive bladder; Incontinence
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-024-05791-7

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.