Effect of neuromodulation on neurogenic bladder in women with multiple sclerosis: a pilot randomized controlled trial

Neurogenic overactive bladder symptoms are very common in patients with multiple sclerosis (MS). In current approaches, neuromodulation methods are preferred. To investigate the effect of transcutaneous posterior tibial nerve stimulation (TPTNS) and repetitive transcranial magnetic stimulation (rTMS) on neurogenic overactive bladder symptoms in patients with MS. Sixteen female MS patients with neurogenic overactive bladder were randomized into TPTNS and rTMS groups for a pilot study. Treatment was blinded to the investigator and statistician but not to patients and physiotherapists. Treatments were applied for a total of 10 sessions over two consecutive weeks. The primary outcome of the study was urodynamic testing, and secondary outcomes were Overactive Bladder Questionnaire-V8 (OAB-V8), Incontinence Severity Index (ISI), Incontinence Quality of Life Scale (I-QOL) and voiding diary applied before and after treatment. In TPTNS and rTMS groups, urodynamic parameters did not show any statistically significant change within and between groups (p > 0.05). Only nocturia frequency provided statistically significant improvement in the TPTNS group compared to the rTMS group (p = 0.01). OAB-V8, ISI and I-QOL parameters did not change significantly between groups (p > 0.05). Although TPTNS and rTMS methods are not superior to each other, they can be used to reduce symptoms and improve quality of life. NCT05312138.