ORIGINAL ARTICLE Prospective and randomized comparison of electrical stimulation of the posterior tibial nerve versus oxybutynin versus their combination for treatment of women with overactive bladder syndrome Sophia C. Souto • Leonardo O. Reis • Thais Palma • Paulo Palma • Fernandes Denardi Received: 15 April 2013 / Accepted: 31 May 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Objective To verify whether the combination of trans- cutaneous electrical neural stimulation (TENS) with oxy- butynin in the treatment of women with overactive bladder (OAB) would be more effective than isolated treatments. Methods We randomized 75 women with OAB, in three groups: GI—30 min TENS, twice a week; GII—daily slow release 10 mg oxybutynin; and GIII—TENS ? oxybutynin (multimodal); all for 12 weeks. Patients were evaluated with validated questionnaires International Consultation on Incontinence-Short Form (ICIQ-SF), International Con- sultation on Incontinence-OAB (ICIQ-OAB), Symptom bother, and 3-day Voiding diary at weeks 0, 12, and 24. Results The groups were similar before treatment. After treatment, all groups significantly improved in OAB symptoms and quality of life (QoL). At week 12, ICIQ- OAB scores were 5.9, 4.6, and 2.9, in groups I, II, and III, respectively, p = 0.01. At week 24, GI and GIII kept the scores of the end of treatment (week 12), while GII increased ICIQ-OAB from 4.6 to 9.2, p = 0.0001, ICIQ-SF from 9.8 to 13.3, p = 0.0006, and Symptom bother score from 3.4 to 7.0, p = 0.0001. Conclusions The multimodal treatment was more effec- tive and TENS alone or in association presented longer lasting results for improvement of clinical symptoms of OAB and QoL. Keywords Overactive bladder Á Anticholinergics Á Transcutaneous electrical neural stimulation (TENS) Á Multimodal treatment Á Non-drug active therapies Á Posterior tibial nerve stimulation (PTNS) Introduction According to the International Continence Society (ICS), the clinical diagnosis of overactive bladder (OAB) is based on symptoms of urinary urgency, with or without urgency incontinence, accompanied by increased urinary frequency and nocturia in the absence of pathological or metabolic factors that would explain these symptoms [1]. The goal of treatment is to decrease the daytime and nighttime urinary frequency, increase voided volume, and decrease episodes of urgency and urgency incontinence, by relaxing the bladder muscle, resulting in improved quality of life (QoL) [2]. Transcutaneous electrical neural stimu- lation (TENS) is a safe and effective alternative for the treatment of OAB, and its efficacy is well documented in the literature [3]. Studies have demonstrated the potential efficacy of combination of treatments [4], which led to the aim of this study, verifying in a prospective randomized study whether the combination of posterior tibial TENS with oxybutynin in the treatment of women with OAB would be more effective than isolated treatments. Electronic supplementary material The online version of this article (doi:10.1007/s00345-013-1112-5) contains supplementary material, which is available to authorized users. S. C. Souto Á L. O. Reis (&) Á T. Palma Á P. Palma Á F. Denardi Division of Urology, School of Medical Sciences, University of Campinas (Unicamp), Rua: Tessa ´lia Vieira de Camargo, 126, Cidade Universita ´ria ‘‘Zeferino Vaz’’, Campinas, SP CEP: 13083-887, Brazil e-mail: reisleo@unicamp.br; reisleo.l@gmail.com L. O. Reis Faculty of Medicine (Urology), Pontifical Catholic University of Campinas (PUC-Campinas), Campinas, Brazil 123 World J Urol DOI 10.1007/s00345-013-1112-5