A comparison of sacral neuromodulation vs. transvaginal electrical stimulation for the treatment of refractory overactive bladder: the impact on quality of life, body image, sexual function, and emotional well-being

Abstract

Overactive bladder syndrome (OAB) is defined by the presence of urinary urgency, with or without urge incontinence, usually accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections (UTI) or other diseases. The overall prevalence of OAB symptoms in the female population is reported to be 16.6% and increases with advancing age and menopause. The aetiology of OAB is not fully understood and is likely to affect a heterogeneous population of patients due to changes to their central and peripheral nervous systems. Although OAB is frequently associated with female sexual dysfunction (FSD), its real impact on sexual function in women has been evaluated only in a few studies. The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination. Many patients who have not had success in managing their symptoms with more conservative therapies may decide to resort to third-line treatments for refractory OAB. These treatments include neuromodulation therapies, particularly transvaginal electrical stimulation (TES) and sacral neuromodulation (SN). The aim of this short commentary is to provide an overview of the effectiveness of these treatments and of their impact on quality of life, body image, sexual function, and emotional well-being.

Sacral electroacupuncture as a treatment for urge urinary incontinence: a prospective case series

“…7 Finally, sacral neuromodulation (SNM) is a surgical procedure in which an electrode is implanted into the S3–S4 sacral foramen to continuously stimulate the third sacral nerve. 8 A 60%–90% improvement rate and 30%–50% cure rate have been reported among women treated for UUI with this approach. 2 However, its common adverse effects include pain (27.8%) 9 and infection (3%–10%) 10 at the implant site.…”

Test–retest reliability of the 20-min pad test with infusion of strong-desired volume in the bladder for female urodynamic stress incontinence

“…OAB is frequently treated by pharmacology, such as antimuscarinics and beta-3 agonists 17 . Refractory OAB can be treated by sacral neuromodulation, transvaginal electrical stimulation or intravesical botox injection 18 , 19 . Based on the finding of good test–retest reliability of the 20-min pad test for women with USI with or without DO, the 20-min pad test seems to be a good tool to assess the severity of SUI with or without OAB.…”

Behavioral therapy versus drug therapy in individuals with idiopathic overactive bladder: A systematic review and meta-analysis

“…Other forms of behavioral therapies, besides those adopted in the studies included in this systematic review, may be used. Intracavitary electrostimulation in women with OAB, using a current with a frequency of 10 Hz, a pulse width of 400 μs and a duty cycle of 10 seconds on and 5 seconds off, with an inten sity varying according to the patient's tolerabil ity, twice a week for 12 weeks, is associated with a 51percent reported symptom reduction rate, as well as with a statistically significant improve ment in emotional domains and subjective per ception of symptom severity (Albertsen, 2005;La Rosa et al, 2019b). The strengthening of the pelvic floor musculature assisted by electromyo graphic biofeedback is also able to promote improvements in the urgency symptoms and a reduction of the number of absorbers used, as well as improvements in the domains of func tional limitations, sleep, and sexual function (Albertsen, 2005;Voorham et al, 2017).…”