Electrical stimulation with non‐implanted electrodes for overactive bladder in adults

Fiona Stewart; Luis F Gameiro; Regina El Dib; Monica O Gameiro; Anil Kapoor; Joao L Amaro

doi:10.1002/14651858.CD010098.pub4

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Figure 1

PRISMA study flow diagram

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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study

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Analysis 1.1

Comparison 1 Electrical stimulation (ES) versus no active treatment, Outcome 1 Number of participants cured or improved.

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Analysis 2.1

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 1 Number of participants cured.

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Analysis 2.2

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 2 Number of participants cured or improved.

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Analysis 2.3

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 3 Number of participants cured or improved: different ES routes.

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Analysis 2.4

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 4 Number of participants satisfied.

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Analysis 2.5

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 5 Number of participants with improvement in urgency urinary incontinence.

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Analysis 2.6

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 6 Number of participants with improvement in urinary frequency.

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Analysis 2.7

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 7 Number of incontinence episodes per 24 h.

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Analysis 2.8

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 8 Number of nocturia episodes.

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Analysis 2.9

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 9 Number of micturitions per 24 h.

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Analysis 2.10

Comparison 2 Electrical stimulation (ES) versus placebo or sham treatment, Outcome 10 Number of participants with adverse effects.

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Analysis 3.1

Comparison 3 Electrical stimulation (ES) versus pelvic floor muscle training (PFMT), Outcome 1 Number of participants cured or improved.

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Analysis 3.2

Comparison 3 Electrical stimulation (ES) versus pelvic floor muscle training (PFMT), Outcome 2 Number of participants satisfied.

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Analysis 4.1

Comparison 4 Electrical stimulation (ES) versus laseropuncture/electro‐acupuncture, Outcome 1 Number of incontinence episodes per 24 h.

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Analysis 5.1

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 1 Number of participants cured.

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Analysis 5.2

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 2 Number of participants cured or improved.

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Analysis 5.3

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 3 Number of participants cured or improved: routes of ES.

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Analysis 5.4

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 4 Number of participants satisfied.

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Analysis 5.5

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 5 Number of incontinence episodes per 24 h.

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Analysis 5.6

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 6 Number of urgency episodes per 24h.

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Analysis 5.7

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 7 Number of micturitions per 24 h.

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Analysis 5.8

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 8 Number of nocturia episodes per night.

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Analysis 5.9

Comparison 5 Electrical stimulation (ES) versus drug therapy, Outcome 9 Number of participants with adverse effects.

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Analysis 6.1

Comparison 6 Electrical stimulation (ES) plus pelvic floor muscle training (PFMT) versus PFMT alone, Outcome 1 Number of participants satisfied.

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Analysis 6.2

Comparison 6 Electrical stimulation (ES) plus pelvic floor muscle training (PFMT) versus PFMT alone, Outcome 2 Number of incontinence episodes per 24h.

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Analysis 6.3

Comparison 6 Electrical stimulation (ES) plus pelvic floor muscle training (PFMT) versus PFMT alone, Outcome 3 Number of urgency episodes per 24 h.

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Analysis 6.4

Comparison 6 Electrical stimulation (ES) plus pelvic floor muscle training (PFMT) versus PFMT alone, Outcome 4 Number of micturitions per 24 h.

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Analysis 7.1

Comparison 7 Electrical stimulation (ES) plus drug therapy versus drug therapy alone, Outcome 1 Quality of life.

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Analysis 7.2

Comparison 7 Electrical stimulation (ES) plus drug therapy versus drug therapy alone, Outcome 2 Number of incontinence episodes per 24h.

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Analysis 7.3

Comparison 7 Electrical stimulation (ES) plus drug therapy versus drug therapy alone, Outcome 3 Number of urgency episodes per 24 hours.

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Analysis 7.4

Comparison 7 Electrical stimulation (ES) plus drug therapy versus drug therapy alone, Outcome 4 Number of micturitions per 24 hours.

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Summary of findings for the main comparison. Electrical stimulation versus no active treatment

Electrical stimulation versus no active treatment
Patient or population: Adults with overactive bladder (OAB) Setting: Hospitals (Brazil and UK) Intervention: Electrical stimulation Comparison: No active treatment
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with no active treatment	Risk with electrical stimulation
Participants cured or improved Follow‐up: range 12 weeks to 12 months	Study population		RR 1.85 (1.34 to 2.55)	121 (2 RCTs)	⊕⊕⊝⊝ LOW ^{1 2}
	424 per 1000	784 per 1000 (568 to 1000)
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life (higher score indicates better quality of life) Follow‐up: range 5 weeks to 12 weeks	In one trial participants in the intervention group had lower ICI‐Q scores (unclear if this was an important difference). In another no evidence of a difference was found between groups in of improvement in a range of QoL scores.		‐	148 (2 RCT)	⊕⊕⊝⊝ LOW ³
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (high likelihood of selection bias). ² Downgraded one level due to serious imprecision (small number of trials, small sample sizes). ³ Downgraded two levels due to very serious imprecision (two trials with small sample sizes).

Summary of findings for the main comparison. Electrical stimulation versus no active treatment

Electrical stimulation versus placebo or sham treatment
Patient or population: Adults with overactive bladder (OAB) Setting: Hospitals (Brazil, Italy, Japan, Taiwan, USA, UK) Intervention: Electrical stimulation Comparison: Placebo or sham treatment
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with placebo or sham treatment	Risk with electrical stimulation
Participants cured or improved Follow‐up: range 4 weeks to 12 weeks	Study population		RR 2.26 (1.85 to 2.77)	677 (10 RCTs)	⊕⊕⊕⊝ MODERATE ¹
	262 per 1000	593 per 1000 (485 to 726)
Participants with improvement in urgency urinary incontinence Follow‐up: range 4 weeks to 13 weeks	Study population		RR 5.03 (0.28 to 89.88)	242 (2 RCTs)	⊕⊕⊝⊝ LOW ^{2 3}
	189 per 1000	948 per 1000 (53 to 1000)
OAB‐related quality of life Follow‐up: range 4 weeks to 13 weeks	3/7 trials reported significantly higher quality of life in the intervention groups. Others reported no evidence of a difference between groups.		‐	627 (7 RCTs)	⊕⊕⊝⊝ LOW ^{2 4}
Adverse effects Follow‐up: median 12 weeks	Study population		RR 1.24 (0.84 to 1.83)	450 (3 RCTs)	⊕⊕⊝⊝ LOW ^{2 5}
	139 per 1000	172 per 1000 (117 to 254)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (high risk of performance and detection bias in one trial; unclear risk of bias in many domains in other trials) ² Downgraded one level due to serious imprecision (small sample sizes and events, wide confidence interval of the pooled effect estimate) ³ Downgraded one level due to serious risk of bias (unclear sequence generation and allocation concealment in the included studies). ⁴ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ⁵ Downgraded one level due to serious risk of bias (unclear risk of selection bias)

Electrical stimulation versus PFMT
Patient or population: Adults with overactive bladder (OAB) Setting: Hospitals (Brazil, Taiwan) Intervention: Electrical stimulation Comparison: PFMT
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with PFMT	Risk with electrical stimulation
Participants cured or improved Follow‐up: median 12 months	Study population		RR 1.60 (1.19 to 2.14)	195 (3 RCTs)	⊕⊕⊕⊝ MODERATE ¹
	390 per 1000	625 per 1000 (465 to 836)
Participants with improvement in urgency urinary incontinence Follow‐up: 6 weeks	Study population		RR 1.62 (0.51 to 5.12)	52 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{2 3}
	382 per 1000	619 per 1000 (195 to 1000)
OAB‐related quality of life assessed with: King's Health Questionnaire (lower scores indicate better quality of life) Follow‐up: 6 weeks	The mean OAB‐related quality of life in the intervention group was 129.81 higher (47.83 higher to 211.79 higher)		‐	49 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{2 3}
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Dowgraded one level due to serious risk of bias (some risk of performance and attrition bias) ² Downgraded two levels due to very serious risk of bias (unclear risk of selection and detection bias) ³ Downgraded two levels due to very serious imprecision (single trial, small sample size, wide confidence interval)

Electrical stimulation versus PFMT plus biofeedback
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Taiwan) Intervention: Electrical stimulation Comparison: PFMT plus biofeedback
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with PFMT plus biofeedback	Risk with electrical stimulation
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence Follow‐up: 6 weeks	Study population		RR 1.06 (0.60 to 1.85)	51 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
	500 per 1000	530 per 1000 (300 to 925)
OAB‐related quality of life Assessed with: King's Health Questionnaire (lower scores indicate better quality of life) Follow‐up: 6 weeks	The mean OAB‐related quality of life in the intervention group was 5.78 lower (88.99 lower to 77.43 higher)		‐	51 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}	No evidence of a difference between groups in quality of life scores
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of selection and performance bias) ² Downgraded one level due to serious imprecision (single trial, small sample size)

Electrical stimulation versus magnetic stimulation
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Japan) Intervention: Electrical stimulation Comparison: Magnetic stimulation
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with magnetic stimulation	Risk with electrical stimulation
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Adverse effects Follow‐up: 4 weeks			Not estimable	32 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}	No events reported in either group
	0 per 1,00	0 per 1,00 (0 to 0)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to very serious imprecision (single trial, small sample size) ² Downgraded one level due to serious risk of bias (unclear risk of selection and performance bias)

Electrical stimulation versus laseropuncture/electro‐acupuncture
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Spain) Intervention: Electrical stimulation Comparison: Laseropuncture/electro‐acupuncture
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with laseropuncture/electro‐acupuncture	Risk with electrical stimulation
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life Assessed with: Bladder Self‐Assessment Questionnaire (lower scores indicate better quality of life) Follow‐up: 12 weeks	The mean OAB‐related quality of life in the intervention group was 2.09 lower (4.1 lower to 0.08 lower)		‐	22 (1 RCT)	⊕⊕⊝⊝ LOW ¹	Significantly greater quality of life in intervention group
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded two levels due to very serious imprecision (single trial, small sample size)

Electrical stimulation versus drug therapy
Patient or population: Adults with overactive bladder (OAB) Setting: Hospitals (Brazil, China, Sweden, Taiwan) Intervention: Electrical stimulation (ES) Comparison: Drug therapy
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with drugs	Risk with electrical stimulation
Participants cured or improved Follow‐up: range 4 weeks to 2 years	Study population		RR 1.20 (1.04 to 1.38)	439 (8 RCTs)	⊕⊕⊕⊝ MODERATE ¹
	585 per 1000	702 per 1000 (608 to 807)
OAB‐related quality of life Follow‐up: range 4 weeks to 6 months	One trial used OAB‐Q, PGII and PPIUS and found a significant result only in the PGII, which was in favour of ES. Another trial found no evidence of a difference between groups in I‐QoL scores. A third trial found higher QoL scores in the ES group at the end of treatment and at 3 months' follow‐up but no evidence of a difference at 6 months' follow‐up.		‐	336 (3 RCTs)	⊕⊕⊝⊝ LOW ^{1 2}
Adverse effects ‐ ES versus oxybutynin Follow‐up: 5 weeks	Study population		RR 0.11 (0.01 to 0.84)	79 (2 RCTs)	⊕⊕⊝⊝ LOW ^{2 3}
	214 per 1000	24 per 1000 (2 to 180)
Adverse effects ‐ ES versus tolterodine Follow‐up: range 4 weeks to 2 years	Study population		RR 0.12 (0.05 to 0.27)	200 (4 RCTs)	⊕⊕⊕⊝ MODERATE ¹
	459 per 1000	55 per 1000 (23 to 124)
Adverse effects ‐ ES versus solifenacin succinate Follow‐up: 4 weeks	Study population		RR 0.09 (0.01 to 1.60)	100 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 4}
	100 per 1000	9 per 1000 (1 to 160)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ² Downgraded one level due to serious imprecision (few trials, small sample sizes) ³ Downgraded one level due to serious risk of bias (high risk of selection and attrition bias) ⁴ Downgraded two levels due to very serious imprecision (single trial, wide confidence intervals)

Electrical stimulation plus PFMT versus PFMT alone
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Belgium, Brazil, USA) Intervention: Electrical stimulation plus PFMT Comparison: PFMT alone
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with PFMT alone	Risk with electrical stimulation plus PFMT
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence Follow‐up: 12 weeks	Study population		RR 2.82 (1.44 to 5.52)	51 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}
	269 per 1000	759 per 1000 (388 to 1000)
Adverse effects Follow‐up: 12 weeks	Study population		Not estimable	51 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{3 4}	No events reported in treatment groups
	0 per 1000	0 per 1000 (0 to 0)
OAB‐related quality of life Follow‐up: range 8 weeks to 6 months	One trial found greater quality of life in the intervention group (measured with ICIQ‐SF). Two other trials found no evidence of a difference between groups (measured with SF‐Qualiveen and York Incontinence Perception Scale)		‐	201 (3 RCTs)	⊕⊕⊝⊝ LOW ^{1 2}
Cost‐effectiveness	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ² Downgraded one level due to serious imprecision (single trial, small sample, wide confidence interval) ³ Downgraded one level due to serious risk of bias (high risk of attrition bias, unclear risk in other domains) ⁴ Downgraded two levels due to very serious imprecision (single trial, small sample size, no events)

Electrical stimulation plus behavioural therapy versus behavioural therapy alone
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Chile) Intervention: Electrial stimulation plus behavioural therapy Comparison: Behavioural therapy
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with behavioural therapy alone	Risk with electrical stimulation plus behavioural therapy
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life Follow‐up: 3 months	Intervention group reported significantly better quality of life measured with OAB‐Q and Incontinence Severity Index		‐	82 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (high risk of attrition bias, low risk of selection bias and unclear in other domains) ² Downgraded two levels due to very serious imprecision (single trial, small sample size, wide confidence interval)

Electrical stimulation plus drug therapy versus drug therapy alone
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Turkey) Intervention: Electrical stimulation plus drug therapy Comparison: Drug therapy
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with drug therapy alone	Risk with electrical stimulation plus drug therapy
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life assessed with: IIQ‐7 (lower scores indicate greater quality of life) Follow‐up: range 12 weeks to 6 months	The mean OAB‐related quality of life in the intervention group was 1.50 lower (3.72 lower to 0.72 higher)		‐	248 (2 RCTs)	⊕⊕⊝⊝ LOW ^{1 2}
Adverse effects Follow‐up: 12 weeks	Study population		RR 0.45 (0.04 to 4.55)	38 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 3}
	111 per 1000	50 per 1000 (4 to 506)
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ² Downgraded one level due to serious imprecision (few trials, confidence intervals do not overlap) ³ Downgraded one level due to very serious imprecision (single trial, small sample size, wide confidence interval)

ES once a week versus ES twice a week
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (USA) Intervention: ES once a week Comparison: ES twice a week
Outcomes	Impact	№ of participants (studies)	Quality of the evidence (GRADE)
Participants cured or improved Follow‐up: 6 months	100% (37/37) of participants in both groups reported improvement in symptoms but only 9/37 were satisfied enough to request no further treatment	37 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Participants with improvement in urgency urinary incontinence	Not reported	(0 studies)	‐
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ² Downgraded two levels due to very serious imprecision (N=37 participants in trial but numbers not reported per group)

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Study	Current	Current intensity	Pulse shape & duration	Frequency (Hz)	Duty cycle	Electrodes	Treatment duration/supervision
Aaronson 1995	Unclear	Unclear	Unclear	Unclear	Unclear	Intravaginal	Unclear
Abdelbary 2015		30‐60 mA according to patient tolerance (mean 43 mA)	320 ms	20	Unclear	Intravaginal	Two 30‐min sessions per week for 12 weeks
Alves 2015	Unclear	"Sensory threshold, activating superficial cutaneous nerve fibers with larger diameter"	200 µs	10	Unclear	Posterior tibial nerve stimulation	Two 30‐min sessions per week for 12 weeks
Alves 2015	Unclear	"Motor threshold, non‐painful contraction is induced and the stimulation can simply make pain relief in the same way that sensory stimulation level (blocking activation of the peripheral or cental inhibition)"	200 µs	10	Unclear	Posterior tibial nerve stimulation	Two 30‐min sessions per week for 12 weeks
Amaro 2006	Bipolar	0‐100 mA according to participant tolerance	Bipolar square wave 0.1 µs	4	2 s on, 4 s off	Intravaginal	Three 20‐min sessions per week on alternate days for 7 weeks
Arruda 2008	Biphasic	10‐100 mA according to participant tolerance	1 ms intermittent	10	Unclear	Intravaginal	Two 20‐min sessions per week for 12 weeks
Barroso 2002	Biphasic	0‐100 mA	Asymmetric, 1 s rise time, sustained for 5 s and resting for 5 s	20	1 s rise time, sustained for 5s and resting for 5 s	Intravaginal	Home use: two 20‐min sessions per day for 12 weeks
Bellette 2009	Unclear	Unclear	Unclear	Unclear	Unclear	Transcutaneous posterior tibial nerve	Two 30‐min sessions per week for 4 weeks
Berghmans 2002	Biphasic	0‐100 mA	Rectangular 200 µs stochastic variation	4‐10	Unclear	Intravaginal	Unclear
Boaretto 2011	Unclear	Unclear	200 µs	10	Unclear	Transcutaneous posterior tibial nerve	Twelve 30‐min sessions
Boaretto 2011	Unclear	Unclear	500 µs	10	Unclear	Intravaginal	Twelve 30‐min sessions
Booth 2013	Unclear	0‐50 mA	200 µs	10	Unclear	Percutaneous tibial nerve stimulation	Two 30‐min sessions per week for 6 weeks
Bower 1998	Unclear	Unclear	200 µs	150	Unclear	Transcutaneous electrical nerve stimulation – suprapubic placement	Unclear
Bower 1998	Unclear	Unclear	200 µs	10	Unclear	Transcutaneous electrical nerve stimulation – sacral placement	Unclear
Brubaker 1997	Bipolar	0‐100 mA	Bipolar square wave 0.1 µs	20	2 s on ‐ 4 s off	Intravaginal	20 minutes daily for 8 weeks
Olmo Carmona 2013	Unclear	0‐10 mA	Square wave 320 µs	20	unclear	Percutaneous posterior tibial nerve stimulation	30 min once a week for 12 weeks
Chen 2015	Bipolar	According to participant tolerance	Continuous bipolar square wave 200 µs	20	Unclear	Percutaneous posterior tibial nerve stimulation ‐ adhesive skin electrodes	Unclear
Eftekhar 2014	Unclear	Unclear	Unclear	Unclear	Unclear	Transcutaneous posterior tibial nerve stimulation ‐ "34 gauge needle placed 5 cm near internal malleolus"	30‐min sessions
Finazzi‐Agrò 2010	Unclear	0‐10 mA, according to participant tolerance	200 µs	20	Unclear	Percutaneous tibial nerve stimulation	Three 30‐min sessions per week for 4 weeks
Firra 2013	Unclear	Unclear current, intensity according to participant tolerance	Unclear	12.5	5 s on, 10 s off	Intravaginal	Fourteen 30‐min sessions
Franzén 2010	Unclear	According to participant tolerance	Unclear	5‐10		Intravaginal/transanal	10 sessions: 1‐2 20‐min sessions per week for 5‐7 weeks
Gaspard 2014	Biphasic	Unclear	Biphasic rectangular 220 µs	10	20 s on, 4 s off	Transcutaneous posterior tibial nerve stimulation: external electrode 5 cm above medial malleolus, 1 cm behind the tibia. The other electrode on dorsum of foot	One 30‐min session per week for 9 weeks
Gonzalez 2015	Unclear	Unclear	Unclear	Unclear	Unclear	Transcutaneous posterior tibial nerve stimulation	Twice a week for 6 weeks, performed by either physiotherapist or continence midwife
Kennelly 2011	Unclear	Unclear	Unclear	Unclear	Unclear	VERV electrode patches, placed by the participant ‐ exact placement unclear	One patch per week for 12 weeks
Kosilov 2013	Diadynamic	20–40 mA, 50%‐75% intensity	Unclear	20	Unclear	Active electrode (50 cm² to 70 cm²) above the pubis, and a passive electrode (150 cm²) in lumbosacral area	15 procedures every other day
Lima 2011	Unclear	Unclear	Unclear	Unclear	Unclear	Intravaginal	Twelve 30‐min sessions
Lima 2011	Unclear	Unclear	Unclear	Unclear	Unclear	Transcutaneous posterior tibial nerve stimulation	Twelve 30‐min sessions
Lin 2004	Unclear	8‐70 mA	Unclear	Unclear	Unclear	Vaginal/anorectal	20‐30 20‐min sessions
Lo 2003	Unclear	According to participant tolerance	Unclear	0‐100	Unclear	Interferential therapy. 2 anterior flat electrodes placed over obturator foramen 1.5 cm to 2 cm lateral to symphysis, two posterior electrodes placed medial to ischial tuberosities either side of anus	12 sessions: first session 15 min, all others 30 min
Lobel 1998	Unclear	Unclear	Unclear	Unclear	Unclear	Intravaginal/transanal	Once per week
Lobel 1998	Unclear	Unclear	Unclear	Unclear	Unclear	Intravaginal/transanal	Twice per week
Manriquez 2013	Unclear	Unclear	Unclear	Unclear	Unclear	Transcutaneous tibial nerve stimulation	Twice a week with at least 48 hour intervals for 12 weeks
Marques 2008	Biphasic	Immediately below motor threshold	200 µs	10	Unclear	Transcutaneous electrical nerve stimulation through 1 channel and 2 electrodes	Two 30‐min sessions per week for 4 weeks
Monga 2011	Unclear	Unclear	Unclear	Unclear	Unclear	Transdermal amplitude‐modulated signal through a patch applied to the skin, controlled by wireless handheld remote control	Patch worn for 4 weeks
Monteiro 2014	Unclear	Below the threshold that causes motor contraction	200 µs	10	Unclear	Posterior tibial nerve stimulation with surface electrodes. Negative electrode on medial malleolus, and the positive electrode 10 cm above negative electrode, also on the medial side. Rhythmic flexion of the second toe during the stimulation determined the correct position of the negative electrode	30‐min twice weekly over 12 sessions (45 days)
Oldham 2013	Unclear	Pre‐programmed to increase intensity over 24 s to reach therapeutic level and switch off automatically after 30 min. All devices same level of stimulation (average intensity considered comfortable and capable of producing contractions of pelvic floor muscles)	Unclear	During the 10 s ‘‘on time’’ the device delivers 10 repeats of a short high intensity burst of 50 Hz stimulation immediately preceded by a doublet (125 Hz), superimposed on continuous low frequency 2 Hz stimulation	10 s on, 10 s off	Intravaginal, single‐use tampon‐like Pelviva device	One disposable device per day for 12 weeks except during menstruation
Orhan 2015	Unclear	Unclear	Unclear	Unclear	Unclear	Percutaneous posterior tibial nerve stimulation	Unclear
Peters 2009	Unclear	Unclear	Unclear	Unclear	Unclear	Percutaneous tibial nerve stimulation: 34‐gauge needle slightly cephalad to medial malleolus	One 30‐min session per week for 12 weeks
Peters 2010	Unclear	0.5‐9 mA	Unclear	20	Unclear	Percutaneous tibial nerve stimulation: 34‐gauge needle inserted at 60º angle 5 cm cephalad to medial malleolus, slightly posterior to tibia. Surface electrode placed on ipsilateral calcaneous	One 30‐min session per week for 12 weeks

Study	Outcome	ES (mean (SD/range), N or n/N; if available)	No active treatment (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Svihra 2002	Improvement in QoL measured by Incontinence Quality of Life Questionnaire, Behavioural Urge Score and International Prostate Symptom Score	5/9	0/9	RR 11.00 (95% CI 0.70 to 173.66)
Oldham 2013	ICI‐Q score¹	Median (range), N: 6 (0‐17), 64	Median (range), N: 9 (3‐18), 60	Not estimable
Secondary outcomes
Marques 2008	Daytime frequency	NR	NR	Favours ES P = 0.0001
Marques 2008	Nocturia	NR	NR	Favours ES P = 0.0186
Monteiro 2014	Participants with nocturnal enuresis	45 days' treatment: 0/12	45 days' treatment: 2/12	Favours ES RR 5.00 (95% CI 1.63 to 15.31)
	Participants with nocturnal enuresis	12 months' follow‐up: 0/12	12 months' follow‐up: 2/12	Favours ES RR 5.00 (95% CI 1.63 to 15.31)
	Participants with nocturia	45 days' treatment: 5/12	45 days' treatment: 9/12	RR 2.33 (95% CI 0.78 to 6.94)
	Participants with nocturia	12 months' follow‐up: 1/12	12 months' follow‐up: 6/12	Favours ES RR 0.17 (95% CI 0.02 to 1.18)
	Participants with increased daytime frequency	45 days' treatment: 3/12	45 days' treatment: 11/12	Favours ES RR 0.27 (95% CI 0.10 to 0.74)
	Participants with increased daytime frequency	12 months' follow‐up: 0/12	12 months' follow‐up: 9/12	Favours ES RR 0.05 (95% CI 0.00 to 0.81)
Results in bold are statistically significant ¹Higher score = greater severity

Study	Outcome	ES (mean (SD/range), N or n/N; if available)	Placebo or sham treatment (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Booth 2013	ICIQ‐SF score	Median (IQR), N: 2 (0 to ‐6), 15	0 (‐3 to 3), 13	P = 0.132
Booth 2013	Participants with improvement in ICIQ‐SF score	10/15	6/13	RR 1.44 (95% CI 0.73 to 2.87)
Bellette 2009	OAB‐Q total score¹	83.99 (16.99), 21	66.63 (25.06), 16	Favours ES MD 17.36 (95% CI 3.09 to 31.63)
Finazzi‐Agrò 2010	I‐QoL score¹	69.9 (65.8‐73.3), 17	70.6 (62.2‐79.1), 15	No evidence of a difference
Kennelly 2011	Change in OAB‐Q score	Median (IQR), N: 8.8 (1.6 to 20.0), 80	Median (IQR), N: 9.2 (‐0.8 to 27.2), 83	P = 0.9918
Peters 2010	Change in OAB‐Q score	36.7 (21.5), 101	29.2 (20.0), 102	Favours ES MD 7.50 (1.79, 13.21)
Yamanishi 2000a	QoL score²	1.6 (0.7), 37	2.2 (0.9), 31	Favours ES MD ‐0.60 (95% CI ‐0.99 to ‐0.21)
Secondary outcomes: clinicians' observations and other quantification of symptoms
Yamanishi 2000a	Number of pads per day	0.8 (1.2), 37	1.1 (2.0), 31	MD ‐0.30 (95% CI ‐1.10 to 0.50)
Other outcomes
Amaro 2006	Participants with reduction in analogue discomfort sensation	8/20	5/20	RR 1.60 (95% CI 0.63 to 4.05)
	Participants with reduction in analogue wetness sensation	6/20	5/20	RR 1.20 (95% CI 0.44 to 3.30)
	Pelvic floor muscle strength (cmH₂O)	53.8 (18.6), 20	46.8 (12.5), 20	MD 7.00 (95% CI ‐2.82 to 16.82)
Yamanishi 2000a	Urgency score²	1.7 (0.7), 37	sham ES: 2 (0.8), 31	MD ‐0.30 (95 CI ‐0.66 to 0.06)
Results in bold are statistically significant ¹Lower score = greater severity ²Higher score = greater severity

ES once a week versus ES three times a week
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Italy) Intervention: ES once a week Comparison: ES 3 times a week
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with ES 3 times a week	Risk with ES once a week
Participants cured or improved (follow‐up not reported)	Study population		RR 0.97 (0.60 to 1.57)	35 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	667 per 1000	647 per 1000 (400 to 1000)
Participants with improvement in urgency urinary incontinence (follow‐up not reported)	Study population		RR 0.80 (0.29 to 2.21)	22 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
	455 per 1000	364 per 1000 (132 to 1000)
OAB‐related quality of life (follow‐up not reported) assessed with: I‐QoL (Higher scores indicate greater quality of life)	I‐QoL scores very similar in the 2 groups (median (range) N): once a week: 77 (35‐100), 17. 3 times per week: 78 (33‐100), 18		‐	35 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Adverse effects (follow‐up not reported)	0 per 1000	0 per 1000 (0 to 0)	not estimable	35 (1 studies)	⊕⊝⊝⊝ VERY LOW ^{1 2}
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (unclear risk of bias in most domains) ² Downgraded two levels due to very serious imprecision (single trial, small sample size, wide confidence intervals around estimate of effect)

Sensory threshold ES versus motor threshold ES
Patient or population: Adults with overactive bladder (OAB) Setting: Hospital (Brazil) Intervention: Sensory threshold ES Comparison: Motor threshold ES
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Quality of the evidence (GRADE)	Comments
	Risk with motor threshold ES	Risk with sensory threshold ES
Participants cured or improved	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
Participants with improvement in urgency urinary incontinence	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
OAB‐related quality of life assessed with: ICIQ‐OAB Follow‐up: 4 weeks	The mean OAB‐related quality of life in the intervention group was 0.07 lower (2.21 lower to 2.07 higher)		‐	28 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}	No evidence of a difference between groups
Adverse effects	See comment	See comment	Not estimable	(0 studies)	‐	Not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
¹ Downgraded one level due to serious risk of bias (low risk of performance, detection and attrition bias but unclear risk of selection bias) ² Downgraded two levels due to very serious imprecision (single trial, small sample, wide confidence interval)

Study	Outcome	ES (mean (SD/range), N or n/N; if available)	PFMT (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Arruda 2008	Participants cured	14/21	12/21	RR 1.17 (95% CI 0.72 to 1.88)
Wang 2004	Participants with improvement in UUI	9/18	13/34	RR 1.62 (95% CI 0.51 to 5.12)
Wang 2004	King's Health Questionnaire score¹	180.08 (176.03), 35	50.27 (171.42), 34	Favours ES MD 129.81 (95% CI 47.83 to 211.79)
Secondary outcomes: clinicians' observations and other quantification of symptoms
Arruda 2008	Incontinence episodes per 24 hours	7.9 (13.7), 21	7.8 (15.3), 21	MD 0.10 (95% CI ‐8.68 to 8.88)
	Micturitions per 24 hours	7.9 (2.3), 21	71. (2.1), 21	MD 0.80 (95% CI ‐0.53 to 2.13)
	Nocturia episodes per night	1.2 (1.3), 21	1 (1.1), 21	MD 0.20 (95% CI ‐0.53 to 0.93)
	Number of pads per day	0.9 (1.7), 21	0.8 (1.3), 21	MD 0.10 (95% CI ‐0.82 to 1.02)
¹Higher score = greater QoL

Study	Outcome	ES plus PFMT (mean (SD/range), N or n/N; if available)	PFMT (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Gaspard 2014	SF‐Qualiveen¹	Median (IQR), N: 9 weeks: 1.000 (0.656, 1.719), 16 6 months: 1.313 (0.687, 1.625), 16.	Median (IQR), N: 9 weeks: 1.375 (0.625, 2.188) 6 months: 1.500 (0.344, 2.094), 15	Not estimable
Firra 2013	York Incontinence Perception Scale²	41.2 (10.2), 6	47 (5.5), 6	MD ‐0.65 (95% CI ‐1.83 to 0.52)
Schreiner 2010	Participants with improvement in UUI	19/25	7/26	Favours ES plus PFMT RR 2.82 (95 CI 1.44 to 5.52)
Schreiner 2010	ICIQ‐SF score¹	7.9 (4.5), 25	10.6 (4.4), 26	Favours ES plus PFMT MD ‐2.70 (95% CI ‐5.14 to ‐0.26)
Secondary outcomes
Schreiner 2010	Nocturia episodes per night	1.3 (1.5), 25	2.4 (1.3), 26	Favours ES plus PFMT MD ‐1.10 (95% CI ‐1.87 to ‐0.33)
Schreiner 2010	Adverse effects	0/25	0/26	Not estimable
Other outcomes
Firra 2013	Pelvic floor muscle strength (cmH₂O)	27 (16), 6	47.2 (22.7), 6	MD ‐20.20 (95% CI ‐42.42 to 2.02)
Results in bold are statistically significant ¹Higher score = greater severity ²Higher score = less severity

Study	Outcome	ES plus behavioural therapy (mean (SD/range), N or n/N; if available)	Behavioural therapy (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Gonzalez 2015	OAB‐Q score¹	100.81 (41.5), 31	127.71 (40.64), 37	Favours ES plus behavioural therapy MD ‐26.90 (95% CI ‐46.52 to ‐7.28)
Gonzalez 2015	Incontinence Severity Index score¹	5.15 (3.23), 31	7.38 (4.00), 37	Favours ES plus behavioural therapy MD ‐26.90, 95% CI ‐46.52 to ‐7.28
Results in bold are statistically significant ¹Higher score = greater severity

Study	Outcome	ES plus drugs (mean (SD/range), N or n/N; if available)	Drugs (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Sancaktar 2010	IIQ‐7 score¹	ES plus tolterodine: 9.0 (0.8), 20	Tolterodine: 11.2 (2.7), 18.	Favours ES plus tolterodine MD ‐2.20 (95% CI ‐3.50 to ‐0.90
Abdelbary 2015		ES plus oestrogen cream:	Oestrogen cream:
Abdelbary 2015	QoL score¹ (instrument not reported)	End of treatment: 2.9 (2.2), 105. 3 months: 1.6 (0.9), 105. 6 months: 2 (0.8), 105.	End of treatment: 5 (1.8), 105 3 months: 6 (2), 105 6 months: 6 (2), 105	MD ‐2.10 (95% CI ‐2.64, ‐1.56] MD ‐4.40 (95% CI ‐4.82 to ‐3.98) MD ‐4.00 (95% CI ‐4.41 to ‐3.59)
Secondary outcomes
Abdelbary 2015		ES plus oestrogen cream:	Oestrogen cream:
	Voids per day	End of treatment: 5 (0.8), 105. 3 months: 5 (0.8), 105. 6 months: 5 (0.8), 105.	End of treatment: 5.0 (0.9), 105 3 months: 5.3 (0.9), 105 6 months: 5.0 (0.8), 105	MD 0.00 (95% CI ‐0.23 to 0.23) MD ‐0.30 (95% CI ‐0.53 to ‐0.07) MD 0.00 (95% CI ‐0.22 to 0.22)
	Nocturia episodes per night	End of treatment: 0.5 (0.5), 105 3 months: 1 (0.9), 105 6 months: 1.5 (0.8), 105	End of treatment: 1.4 (0.8), 105 3 months: 1.5 (0.5), 105 6 months: 5 (0.8), 105	MD ‐0.90 (95% CO ‐1.08 to ‐0.72) MD ‐0.50 (95% CI ‐0.70 to ‐0.30) MD ‐3.50 (95% CI ‐3.72 to ‐3.28)
	Incontinence episodes per 24 hours	End of treatment: 1.4 (0.7), 105 3 months: 0.09 (0.28), 105. 6 months: 0.09 (0.28), 105.	End of treatment: 0.4 (0.6), 105 3 months: 0.5 (0.6), 105 6 months: 0.4 (0.6), 105	MD 1.00 (95% CI 0.82 to 1.18) MD ‐0.41 (95% CI ‐0.54 to ‐0.28) MD ‐0.31 (95% CI ‐0.44 to ‐0.18)
	Urgency episodes per 24 hours	End of treatment: 1.4 (0.7), 105 3 months: 1.6 (0.9), 105 6 months: 2 (0.8), 105	End of treatment: 4 (1.3), 105 3 months: 4.5 (1.5), 105 6 months: 4 (1.3), 105	MD ‐2.60 (95% CI ‐2.88 to ‐2.32) MD ‐2.90 (95% CI ‐3.23 to ‐2.57) MD ‐2.00 (95% CI ‐2.29 to ‐1.71)
Sancaktar 2010	Adverse effects	ES plus tolterodine: 1/20	Tolterodine: 2/18	RR 0.45 (95% CI 0.04 to 4.55)
Results in bold are statistically significant ¹Higher score = greater severity

Study	Outcome	ES A (mean (SD/range), N or n/N; if available)	ES B (mean (SD), N or n/N; if available)	Result
Primary outcomes: cure/improvement of OAB symptoms; OAB‐related quality of life
Alves 2015	ICIQ‐OAB score¹	Tibial nerve stimulation: sensory threshold activating superficial cutaneous nerve fibres with larger diameter: 4.46 (2.66), 15	Tibial nerve stimulation: motor threshold, non‐painful contraction is induced: 4.53 (3.07), 13	MD ‐0.07 (95% CI ‐2.21 to 2.07)
Finazzi‐Agrò 2005	Success = > 50% reduction in micturitions/24 hours OR If incontinent, success > 50% reduction in UI episodes/24 hours	ES once a week: 11/17 (4/11 incontinent participants)	ES 3 times per week: 12/18 (5/11 incontinent participants)	RR 0.97 (95% CI 0.60 to 1.57) Incontinence participants: RR 0.80 (95% CI 0.29 to 2.21)
Finazzi‐Agrò 2005	I‐QoL score²	ES once a week (median, range, N): 77 (35‐100), 17	ES 3 times a week (median, range, N): 78 (33‐100), 18	Not estimable
Lobel 1998	Participants with improvement in symptoms	ES once a week: 100%	ES twice a week: 100%	Not estimable
Lobel 1998	Participants satisfied enough to request no further treatment	24% (9/37)		Not estimable, not reported per treatment group
Secondary outcomes: clinicians' observations and other quantification of symptoms
Finazzi‐Agrò 2005	Adverse effects	ES once a week: 0/17	ES 3 times per week: 0/18	Not estimable
	Subjective improvement after 6‐8 sessions	ES once a week: 17/17	ES 3 times a week: 18/18	Not estimable
	Incontinence episodes per 24 hours	ES once a week (median, range, N): 1 (0‐3), 11	ES 3 times a week (median, range, N): 1 (0‐3), 11	Not estimable
	Micuturitions per 24 hours	ES once a week (median, range, N): 8 (5‐15), 17	ES 3 times a week (median, range, N): 8 (6‐18), 18	Not estimable
	SF‐36 score	ES once a week (median, range, N): 62 (24‐81), 17	ES 3 times per week (median, range, N): 62 (25‐80), 18	Not estimable
Alves 2015	UUI episodes per 24 hours	Tibial nerve stimulation: sensory threshold activating superficial cutaneous nerve fibres with larger diameter: 0.33 (0.57), 15	Tibial nerve stimulation: motor threshold, non‐painful contraction is induced: 0.84 (1.39), 13	MD ‐0.51 (95% CI ‐1.32 to 0.30)
	Urgency episodes per 24 hours	Tibial nerve stimulation: sensory threshold activating superficial cutaneous nerve fibres with larger diameter: 0.79 (0.97), 15	Tibial nerve stimulation: motor threshold, non‐painful contraction is induced: 0.58 (0.65), 13	MD 0.21 (95% CI ‐0.39 to 0.81)
	Micturitions per 24 hours	Tibial nerve stimulation: sensory threshold activating superficial cutaneous nerve fibres with larger diameter: 8.33 (2.52), 15	Tibial nerve stimulation: motor threshold, non‐painful contraction is induced: 7.89 (2.64), 13	MD 0.44 (95% CI ‐1.48 to 2.36)
	Nocturia episodes per night	Tibial nerve stimulation: sensory threshold activating superficial cutaneous nerve fibres with larger diameter: 1.26 (1.21), 15	Tibial nerve stimulation: motor threshold, non‐painful contraction is induced: 1.05 (1.01), 13	MD 0.21 (95% CI ‐0.61 to 1.03)
Bower 1998	Maximum cystometric capacity	150 Hz: 351 (144), 16	10 Hz: 305 (146), 16	MD 46.00 (95% CI ‐54.48 to 146.48)
Bower 1998	Volume at first desire to void	150 Hz: 208.5 (132), 16	10 Hz: 154 (61), 16	MD 54.50 (95% CI ‐16.75 to 125.75)
Other outcomes
Boaretto 2011	Participants satisfied	200 µs pulse width: 17/22	500 µs pulse width: 11/16	RR 1.12 (95% CI 0.75 to 1.68)
¹Higher score = greater severity ²Lower score = greater severity

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Number of participants cured or improved Show forest plot	2	121	Risk Ratio (M‐H, Fixed, 95% CI)	1.85 [1.34, 2.55]

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