title: The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum toxin?
abstract: OBJECTIVE
  We have reviewed the evidence published on botulinum toxin A (BoNT/A), percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation (SNS) in the management of overactive bladder (OAB).
  
  
  RESULTS
  BoNT/A is effective irrespectively of the number of previous anticholinergic treatments and of the reason for failure. Doses up to 360U 3-monthly are well tolerated. BoNT/A is well tolerated and effective also in the pediatric population. Bladder instillation of liposome encapsulated BoNT/A is a new approach, deserving further research. When using PTNS, motor response from the electrical stimulus is not required, a sensory response suffices. PTNS has a lasting effect compared to oxybutynin alone. SNS is superior to standard medical treatment but the combination of SNS and anticholinergics is more effective than anticholinergic alone.
  
  
  CONCLUSIONS
  The evidence published in the last 18 months has increased the level of evidence on safety and effectiveness of BoNT/A, PTNS, and SNS in the management of OAB. BoNT/A is now recommended as standard third-line treatment for OAB (in the USA) and urgency incontinence (in the USA and in Europe) in selected patients refractory to pharmacological therapy. All available third-line treatment options for OAB/urgency urinary incontinence should be offered before surgery is contemplated.
  http://links.lww.com/COU/A7.
authors.affiliation: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Sapienza University of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Federica
authors.initials: F
authors.lastname: Puccini
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
mesh_terms: D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008160:Lumbosacral Plexus; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D013979:Tibial Nerve; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*
chemical_list: D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A