OVERACTIVE bladder (OAB) syndrome, defined by the International Continence Society (ICS), is characterised by urinary urgency, often coupled with increased frequency and nocturia, and sometimes urgency urinary incontinence, excluding urinary tract infections. It affects around 12.8% of women in the general population, rising to 20–30% in women over 65. OAB significantly impacts quality of life, daily activities, sleep, and mental health.
Treatment options for OAB include behavioural therapy as a first-line intervention, pharmacological treatments such as antimuscarinic drugs and β3-adrenoceptor agonists as second-line, and advanced therapies like tibial nerve stimulation and sacral neuromodulation for refractory cases.
Emerging therapies combining Transcutaneous Tibial Nerve Stimulation (TTNS) and the β3-adrenoceptor agonist mirabegron offer promising results. TTNS is a non-invasive neuromodulation technique targeting the tibial nerve, which shares neural pathways with the bladder. Mirabegron, meanwhile, relaxes the detrusor muscle during the bladder storage phase, increasing capacity without the side effects of antimuscarinic drugs.
A recent randomised trial evaluated the efficacy and safety of this combination therapy in women with OAB. Compared to mirabegron monotherapy, the combined approach significantly improved urinary urgency, frequency, and nocturia. Improvements were evident within six weeks and sustained over three months. The treatment’s safety profile was comparable to mirabegron alone, with no notable increase in adverse effects.
The combination therapy’s enhanced efficacy may stem from the synergistic mechanisms of TTNS and mirabegron, targeting both neural regulation and bladder muscle function. Previous studies have also shown that multimodal approaches yield superior outcomes in managing OAB symptoms.
While the study underscores the potential of TTNS and mirabegron as a safe, effective combination, limitations such as a small sample size and short follow-up period suggest a need for further research. Future investigations could explore long-term outcomes, cost-effectiveness, and applicability across diverse patient populations.
This combination therapy marks a step forward in OAB management, offering improved symptom control and quality of life for affected individuals.
Reference
Xu YX et al. Efficacy of the combination of transcutaneous tibial nerve stimulation and mirabegron in women with overactive bladder in a prospective randomized controlled trial. Sci Rep. 2024;14(1):27248.
