Peroneal electrical transcutaneous nerve modulation appears safe and tolerable for treating overactive bladder (OAB), investigators report.
Traditional targets for OAB treatment include the sacral, pudendal, and tibial nerves. The peroneal nerve is more superficial and accessible and could be a target for noninvasive stimulation.
In a preliminary trial, investigators randomly assigned 77 treatment-naïve patients in a 2:1 ratio to daily, at-home peroneal electrical transcutaneous neuromodulation using the URIS system or 5 mg/day oral solifenacin for 12 weeks.
The primary outcome was safety. Treatment-related adverse events occurred in a significantly lower proportion of the peroneal neuromodulation than solifenacin group: 12% vs 48%, Jan Krhut, MD, PhD, of University Hospital in Ostrava, Czech Republic, and colleagues reported in The Journal of Urology. The most common adverse effects were transient erythema and mild pain at the site of peroneal nerve stimulation or dry mouth and constipation with solifenacin.
Although the trial was underpowered to assess efficacy, the team assessed exploratory endpoints in post hoc analyses. The proportion of responders with a 50% or greater reduction in symptoms was similar in the peroneal neuromodulation and solifenacin groups with respect to Patient Perception of Intensity of Urgency Scale grade 3 urgency episodes (87% vs 74%), grade 3+4 urgency episodes (87% vs 75%), and urgency incontinence episodes (90% vs 94%). The investigators observed significant improvement over time in other efficacy variables in both treatment arms. Solifenacin displayed rapid onset. Patients in the peroneal neuromodulation group reported greater improvement in quality of life.
Due to its noninvasiveness, tolerability, ease of use, and suitability for home-based treatment, peroneal nerve stimulation might be considered before sacral nerve modulation or intravesical botulinum toxin injections, according to Dr Krhut’s team.
In an accompanying editorial, Kenneth M. Peters, MD, of Corewell Health William Beaumont University Hospital in Royal Oak, Michigan, and Ly Hoang Roberts, MD, of Cleveland Clinic in Ohio, suggested that a sham-controlled trial with alternative electrode placement or a randomized trial comparing posterior tibial nerve stimulation to peroneal nerve stimulation would help solidify the novel therapy’s efficacy.
Disclosure: This research was supported by StimVia. Please see the original reference for a full list of disclosures.
Krhut J, Rejchrt M, Slovak M, et al. Prospective, randomized, multicenter trial of peroneal electrical transcutaneous neuromodulation vs solifenacin in treatment-naïve patients with overactive bladder. J Urol. doi:10.1097/JU.0000000000003141
Hoang Roberts L, Peters KM. Does cutaneous stimulation of the peroneal nerve treat overactive bladder? J Urol. doi:10.1097/JU.0000000000003203