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The peroneal nerve follows sacral, pudendal, and tibial nerves as a target for overactive bladder (OAB) treatment. This multicentre prospective randomised RCT compared a transcutaneous electrical neuromodulation system (eTNM) at-home treatment once daily for 30 minutes to solifenacin 5mg once daily. The device is attached to the thigh and optimal stimulation of the peroneal nerve elicits a motor response of rhythmic feet movement. Data was available in 72 treatment naïve female patients, 47 in the eTNM arm and 25 in the solifenacin arm. Efficacy was judged from bladder diary and symptom questionnaire data, with significant improvement in all variables in both groups. At 12 weeks, urgency improved in 87% vs. 75% and 90% vs. 94% with respect to urgency incontinence. The onset of efficacy was more rapid with solifenacin. The primary endpoint was however device safety which was confirmed to be well tolerated; treatment-related adverse effects were lower in the e-TNM group with the most frequent complaints being transient erythema, a rash or discomfort at the stimulation site, and moderate headache in about 8% of patients. Clinical efficacy was a secondary objective which the study was not powered adequately for, and therefore this early data is not conclusive regarding effectiveness between the two treatments. Although a home-use minimally invasive treatment may seem attractive, animal study data has been conflicting and a placebo effect is well recognised with neuromodulation. Consequently, further well-designed trials will be necessary.

Prospective, randomized, multicenter trial of peroneal electrical transcutaneous neuromodulation vs solifenacin in treatment-naïve patients with overactive bladder.
Krhut J, Rejchrt M, Slovak M, et al.
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Jay Khastgir

Princess of Wales Hospital, Bridgend & Swansea University School of Medicine.

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