The management of overactive bladder percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum toxin?Tubaro, Andrea; Puccini, Federica; De Nunzio, CosimoCurrent Opinion in Urology: July 2015 - Volume 25 - Issue 4 - p 305–310 doi: 10.1097/MOU.0000000000000180 EVIDENCE BASED UROLOGY: RELATION TO FEMALE UROLOGY: Edited by Christopher R. Chapple Buy SDC Abstract Author InformationAuthors Article MetricsMetrics Purpose of review 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). Recent findings 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. Summary 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. Video abstract http://links.lww.com/COU/A7. Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Sapienza University of Rome, Italy Correspondence to Andrea Tubaro, MD, FEBU, Department of Urology, Sant’Andrea Hospital, Department of Clinical and Experimental Medicine, Sapienza University of Rome, Rome, Italy. Tel: +6 3377 5469; fax: +6 3377 5059; e-mail: email@example.com Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.co-urology.com). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.