UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

OVERACTIVE BLADDER INTERVENTIONAL METHODS

İsmail Bağlar1 Naif Çiçekli2

1Kartal Dr. Lütfi Kırdar City Hospital, Department of Gynecology and Obstetrics, İstanbul, Türkiye,
2Erzurum City Hospital, Department of Gynecology and Obstetrics, Erzurum, Türkiye

Bağlar İ, Çiçekli N. Overactive Bladder Interventional Methods. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.129-138.

ABSTRACT

Overactive bladder (OAB) is a chronic and often progressive condition characterized by the sudden and compelling urge to urinate, which can frequently be accompanied by increased urinary frequency, nocturia, and in some cases urgency-type urinary incontinence. These symptoms not only cause physical discomfort but also significantly impair quality of life, leading to social, emotional, and even occupational limitations. Current treatment strategies are generally divided into stepwise approaches. The first step involves behavioral and lifestyle modifications, including fluid management, bladder training, and pelvic floor exercises. When these methods are insufficient, the second step consists of pharmacological agents, most commonly antimuscarinic drugs or b3-adrenoceptor agonists. However, a considerable proportion of patients either fail to achieve satisfactory symptom control with these options or discontinue therapy due to adverse effects such as dry mouth, constipation, or hypertension. This condition is defined as refractory OAB and necessitates further interventional management.

In this section of our book, we provide a comprehensive review of the principal interventional methods for refractory OAB, including intradetrusor botulinum toxin A (BoNT-A) injections, sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and its non-invasive alternative, transcutaneous tibial nerve stimulation (TTNS). For each of these treatment modalities, the mechanism of action, technical aspects of application, clinical efficacy, durability of response, patient selection criteria, and potential adverse events are summarized based on the most recent literature. In addition, other emerging interventions, such as selective bladder denervation procedures and novel laser-based therapies, are briefly outlined as future alternatives under investigation.

Ultimately, interventional therapies represent an essential component in the management algorithm of refractory OAB. The decision regarding which method to employ should ideally be made within a multidisciplinary framework, carefully weighing the patient’s individual characteristics, comorbidities, symptom severity, and personal expectations. This patient-centered and evidence-based approach offers the best chance of improving both symptom burden and quality of life for individuals affected by refractory OAB.

Keywords: Transcutaneous electric nerve stimulation; Urinary bladder, overactive

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