Electrical Nerve Stimulation for Overactive Bladder a Comparison of Treatments

To compare the long-term efficacy, subject compliance, and subject satisfaction of
percutaneous tibial nerve stimulation (PTNS) therapy versus transcutaneous electrical sacral
nerve stimulation (TENS) for the treatment of subjects with idiopathic overactive bladder.
Previous short-term studies suggest that these therapies have equal efficacy in improving
OAB symptoms, but we hypothesize that long-term efficacy and success is actually higher in
the TENS group due to ease of use, since subjects can self-administer this therapy.
Secondary goals are to evaluate subject quality of life improvement scores, bladder diary
scores (change in the frequency of urination), and changes in urodynamic studies while
undergoing these therapies.

Inclusion Criteria:

- Female

- Age >18 years

- Predominant complaint urge urinary incontinence (3 or more episodes per week) OR
overactive bladder (8 or more voids per day, and/or 2 or more voids per night)

- Failed trial of conservative therapy (bladder training, fluid modification, diet
modification, caffeine restriction, pelvic floor training)

- Failed trial of anticholinergic either due to inability to take the medication,
adverse reaction to medication, or no improvement on medication

- Willing and mentally competent to participate in study

- Willing to complete study questionnaires

- No contraindications to undergoing PTNS or TENS therapy

Exclusion Criteria:

- Age < 18 years

- Presence of urinary fistula

- Male. (Males will be excluded because of the different etiology of overactive bladder
for males which is primarily caused by prostate problems for men versus the primarily
idiopathic cause in women).

- Recurrent or current urinary tract infection (5 or more infections in the last 12
months)

- Bladder stones

- Bladder cancer or suspected bladder cancer

- Hematuria

- Pregnancy or planning to become pregnant during the study (urine pregnancy test will
be administered to those who are premenopausal and who have not had a hysterectomy)

- Central or peripheral neurologic disorders such as Multiple Sclerosis, Parkinson's
disease, spina bifida, or other spinal cord lesion

- Metal implants such as pacemaker, implantable defibrillator, or metal implants where
PTNS or TENS device needs to be placed (sacrum or ankle/leg).

- Uncontrolled diabetes

- Diabetes with peripheral nerve involvement

- On anticoagulants

- Current use of anticholinergics or use within the last 4 weeks

- Current use of botox bladder injections or bladder botox injection within the last
year

- Current use of interstim therapy or currently implanted interstim device or leads

- Bladder outlet obstruction

- Urinary retention or gastric retention

- Painful Bladder Syndrome/Interstitial Cystitis