Physical Agent-Based Treatments for Overactive Bladder: A Review

Abstract

Almost one-fifth of the people in the world experience a decrease in quality of life due to overactive bladder (OAB) syndrome. The main bothersome symptoms are urgency accompanied by urinary frequency and nocturia. This chronic, disabling condition is first managed by reducing fluid intake and pelvic floor muscle training, supplemented with antimuscarinic drugs, if necessary. However, refractory cases often still occur. In more severe cases, invasive surgical interventions can be considered; yet, the success rate is still inconsistent, and there is a high complication rate. This condition is frustrating for patients and challenging for the medical staff involved. Although its pathophysiology has not been fully elucidated, peripheral autonomic somatic and sensory afferent receptors are considered to be involved in this condition. Hence, currently, physical agent-based treatments such as neuromodulation have taken a significant place in the third-line therapy of OAB. The efficacy and safety profiles of electrical and magnetic stimulation continue to evolve. Physical-based agents provide an appealing option owing to their effectiveness and minimal side effects. In addition, more physical therapies using light and shock energy are currently being investigated. Thus, a comprehensive understanding of these modalities is an extremely important aspect to provide the most suitable modalities for patients.

Keywords: electrical stimulation; laser; low-intensity shock energy; magnetic stimulation; neuromodulation; overactive bladder; physical-based agent.

Figure 1

Classification of physical-based agents as third-line options for overactive bladder (OAB). The classification is followed by the stimulation area and the way it is applied.

Figure 2

Illustration of the electrodes and needle position for percutaneous posterior tibial nerve stimulation (P-TNS) therapy. The needle is inserted parallel to the tibial nerve.