Treatment Of Refractory Overactive Bladder Research Articles

Clinical efficacy and safety analysis of type A botulinum toxin in the treatment of adolescents with refractory overactive bladder.

The objective of this study was to assess the clinical effectiveness and safety of type A botulinum toxin in the treatment of refractory overactive bladder in adolescents. We conducted a retrospective analysis of 37 adolescent patients with refractory overactive bladder who were treated at the Urology Department of Hangzhou Third People's Hospital between January 2018 and August 2023. These patients received intravesical injections of type A botulinum toxin at a concentration of 10 U/mL, with an average of 20 injection points. We recorded changes in urination diaries and urodynamic parameters both before and 1 month after treatment. After 1 month of treatment, significant improvements were observed in several parameters, when compared to the pretreatment values. These included daytime frequency of urination (11.13 ± 6.45), average single void volume (173.24 ± 36.48) mL, nighttime frequency of urination (2.43 ± 0.31), urgency episodes (3.12 ± 0.27), initial bladder capacity (149.82 ± 41.34) mL, and maximum bladder capacity (340.25 ± 57.12) mL (all P < .001). After the first treatment, 5 patients had mild hematuria, 4 patients had urinary tract infection, and 1 patient had urinary retention, which was relieved after catheterization. No serious complications or adverse reactions were observed in other patients. The follow-up period ranged from 6 to 18 months, and the duration of efficacy varied from 2 to 8 months. Eight patients who initially had treatment failure achieved symptom relief after reinjection. In adolescents with refractory overactive bladder who do not respond well to conventional drug therapy, type A botulinum toxin can be administered safely and effectively. It significantly improves lower urinary tract symptoms and enhances the quality of life for these patients.

Efficacy of sacral neuromodulation in the treatment of refractory overactive bladder and non-obstructive urinary retention –A preliminary report

Efficacy of sacral neuromodulation in the treatment of refractory overactive bladder and non-obstructive urinary retention –A preliminary report

Do patients experience decisional regret after sacral neuromodulation for refractory overactive bladder?

Success following urological procedures is traditionally defined through objective endpoints. This approach may not capture the impact on patient satisfaction. There is a paucity of literature evaluating patient-centered metrics such as satisfaction and decisional regret in the field of urology. This study investigates long-term satisfaction and decisional regret amongst patients who underwent sacral neuromodulation (SNM) for the treatment of refractory overactive bladder (OAB). This study retrospectively reviewed patients who underwent SNM for refractory OAB from 2015 to 2022 at a single institution serving an ethnically diverse and underrepresented community. Demographic data were collected through chart review and surveys conducted via telephone calls. Patient satisfaction and decisional regret was measured with the validated modified SDS-DRS scale (satisfaction with decision scale-decision regret scale). Descriptive statistics, Wilcoxan rank sum, and median regression analyses were performed using STATA 15.0 with p < 0.05 as significant. Out of 191 patients who underwent SNM, 63 were unreachable (wrong number in chart, number not in service, patient did not answer, deceased). Eighty-nine out of 128 patients reached agreed to participate (70% response rate). The mean time since surgery was 37.3 ±25.2 months. The median satisfaction with decision score was 4.0 (IQR: 3.7-4.7) with a score of 1 correlating with low satisfaction and a score of 5 correlating with high satisfaction. The median decisional regret score was 2.0 (IQR: 1.2-2.9)with a score of 1 correlating with low decisional regret and a score of 5 correlating with strong decisional regret. Ten patients reported complications after surgery, which was significantly associated with lower SDS and higher DRS scores (p < 0.01), and persisted after adjusting for age, body mass index, sex, and comorbidities (SDS β coef: -0.84, 95% CI: -1.5 to0.15,p = 0.02;DRS β coef: 1.48, 95% CI:0.55-2.41,p < 0.01). Patients who underwent SNMfor refractory OAB overall had low regret and high satisfaction with their decision at an average 3 years of follow-up. As expected, those who developed postoperativecomplications had worse scores. The inclusion of patient-centric outcomes is imperative when determining the success of a surgical procedure and is useful for shared decision-making when advancing to third-line therapy for OAB. Longer-term follow-up is necessary to assess durability of high satisfaction and low regret over time.

Efficacy of Intravesical Botulinum Toxin A Injection in the Treatment of Refractory Overactive Bladder in Children.

This study aimed to evaluate the efficacy of intravesical botulinum toxin A (BoNT-A) injections for the treatment of pediatric overactive bladder (OAB) by exploring the differential treatment outcomes in children with different OAB etiologies and those who received additional intrasphincteric BoNT-A injections. We performed a retrospective review of all pediatric patients who received intravesical BoNT-A injections between January 2002 and December 2021. All patients underwent a urodynamic study at baseline and three months after BoNT-A administration. A Global Response Assessment (GRA) score of ≥2 at three months after BoNT-A injection was defined as successful treatment. Fifteen pediatric patients (median age, 11 years), including six boys and nine girls, were enrolled in the study. A statistically significant decrease in detrusor pressure from baseline to three months postoperatively was observed. Thirteen (86.7%) patients reported successful results (GRA ≥ 2). The cause of OAB and additional intrasphincteric BoNT-A injections did not affect the improvement in urodynamic parameters and treatment success. The study demonstrated that intravesical BoNT-A injection is effective and safe for the treatment of neurogenic and non-neurogenic OAB in children refractory to conventional therapies. Additionally, intrasphincteric BoNT-A injections do not provide additional benefits in the treatment of pediatric OAB.

Intravesical Injection of Botulinum Toxin Type A in Patients with Refractory Overactive Bladder-Results between Young and Elderly Populations, and Factors Associated with Unfavorable Outcomes.

Intravesical botulinum toxin type A (BoNT-A) injection has been recognized as the standard treatment for refractory overactive bladder (OAB). However, its therapeutic efficacy and safety have not been thoroughly reviewed in elderly patients. This study aims to provide treatment outcomes for patients aged ≥75 years, and to identify factors associated with unfavorable outcomes. Patients receiving intradetrusor injections of 100 U onabotulinumtoxinA for refractory OAB between 2011 and 2021 were retrospectively reviewed. Urodynamic parameters, underlying comorbidities, subjective success, and unfavorable outcomes were assessed. A total of 192 patients were included, and 65 of them were classified into the elderly group. For the elderly group, 60.0% experienced subjective dryness, and 84.6% remained subjective success at 6 months after the injections. The prevalence rates of common unfavorable outcomes, including urinary tract infections, large post-void residual urine volume, and urinary retention, were 9.2%, 27.7%, and 12.3%, respectively. Multivariate analysis revealed that female, baseline urodynamic parameters, and diabetes mellitus were associated with unfavorable outcomes in the elderly group. Intravesical BoNT-A injections provide comparable therapeutic efficacy and safety concerns in elderly patients with refractory OAB. A thorough consultation for treatment benefits and possible adverse events is mandatory before the procedure.

This Month in Adult Urology

This Month in Adult Urology

Intravesical Instillation of OnabotulinumtoxinA in the Treatment of Refractory Overactive Bladder in Participants with Urinary Incontinence.

Intradetrusor injections of onabotulinumtoxinA are efficacious for the treatment of overactive bladder with urgency urinary incontinence in adults refractory to or intolerant of anticholinergics. Delivery of onabotulinumtoxinA via instillation would reduce the need for intradetrusor injections. The objective of this trial was to assess the efficacy and safety of intravesical instillation of an onabotulinumtoxinA + hydrogel admixture. After review of a stage 1 safety phase by an independent committee, participants were recruited into stage 2 and randomized to either onabotulinumtoxinA 100, 300, 400, or 500 U, or placebo, all with hydrogel admixture. End points included change from baseline to week 12 in the number of urinary incontinence episodes (primary); micturition, urgency urinary, and nocturia episodes/day; volume voided per micturition; proportion of participants with a ≥50% decrease from baseline in urinary incontinence episodes/day; and Overactive Bladder Questionnaire total score. Adverse events were reported. Change from baseline to week 12 in number of urinary incontinence episodes was -2.72 with placebo and ranged from -0.89 to -1.85 in the onabotulinumtoxinA + hydrogel treatment groups. No difference from placebo was observed for any efficacy end point. The proportions of participants with treatment-emergent adverse events were similar among all groups, with asymptomatic bacteriuria the highest reported (6.7%-15.5%). There were no reports of urinary retention or elevated post-void residual volume. Intravesical instillation of an onabotulinumtoxinA + hydrogel admixture for the treatment of refractory overactive bladder was well tolerated, but it showed no improvement over placebo.

Cannabidiol in the treatment of Refractory Overactive Bladder: cases report

Cannabidiol in the treatment of Refractory Overactive Bladder: cases report

Treatment of refractory overactive bladder with OnabotulinumtoxinA vs PTNS: TROOP trial.

We hypothesized that patients with refractory overactive bladder (rOAB) have similar improvement with percutaneous tibial nerve stimulation (PTNS) and OnabotulinumtoxinA (BTX). This multicenter cohort study compared BTX and PTNS in women with rOAB. Baseline information included Overactive Bladder Questionnaire (OABq) short form, Urinary Distress Inventory-6 (UDI-6), and voiding diary. Primary outcome was cure, defined as "very much better" or "much better" on the Patient Global Impression of Improvement (PGII) AND a reduction in OABq symptom severity scale (SSS) ≥10 at 3 months after treatment. Assuming 80% power to detect a ten-point difference in OABq-SSS, 80 participants were required per group. A total of 150 patients were enrolled; 97 completed 3 months of therapy and were included. At baseline, BTX patients had more detrusor overactivity (70% vs 40%, p= 0.025), urgency incontinence (UUI; OABq-SSS#6 4 vs 3, p = 0.02, SSS 65 vs 56, p= 0.04), but similar health-related quality of life (HRQL 49 vs 54, p= 0.28), voids (7 vs 8, p= 0.13), and UUI episodes (2 vs 2, p= 1.0). At 3months, cure rates were similar: BTX 50% vs PTNS 44.2% (p= 0.56). Both groups had improved SSS (-37 vs -29, p= 0.08) and HRQL (31 vs 24, p= 0.14). Patients receiving BTX had a greater improvement in urgency (ΔOABq-SSS#2-3 vs -2; p= 0.02) and UUI (ΔOABq-SSS#6-2 vs -1; p = 0.02). No characteristics were predictive of cure. BTX resulted in significantly greater improvement in urgency and UUI than PTNS, but no difference in success based on PGII and OABq-SSS, which may be due to a lack of power.

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder.

PurposeIntradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.Patients and MethodsThis retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients’ outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.ResultsTwenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2–2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.ConclusionIntradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

Percutaneous tibial nerve stimulation versus sham efficacy in the treatment of refractory overactive bladder: outcomes following a shortened 6‐week protocol, a prospective randomized controlled trial

It is a prospective randomized controlled trial comparing the efficacy of percutaneous tibial nerve stimulation versus sham for a shortened 6-week protocol of treatment in management of refractory OAB in non-neurogenic adult patients. A total of 50 adults with refractory non-neurogenicoveractive bladder symptoms were randomized 1:1 to 6weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder symptom score as well as 3-day voiding diaries were completed at baseline and at 7th week, 3rd and 6th month. The 7th week, 3rd and 6th month symptom score assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation patients achieved statistically significant improvement in bladder symptoms with 52% reporting moderately improved responses compared to non-response of sham patients from baseline (P = 0.001). Voiding diary parameters after 6weeks of therapy showed that PTNS patients had statistically significant improvements in frequency, voided volume and urgency urinary incontinence episodes compared to sham. No serious device-related adverse events or malfunctions were reported. A shortened 6-week treatment protocol with PTNS appears to be successful and more effective than sham in the treatment of refractory OAB. PTNS therapy is safe and effective in treating OAB symptoms with 52% success rate following a shortened 6-week protocol. The duration of treatment with PTNS can be halved compared to the conventional 12weeks, which would make it more acceptable and cost effective for patients.

PD06-08 EXPLANTED SACRAL NERVE STIMULATORS CONSISTENTLY EXHIBIT BIOFILMS WITH DIVERSE MICROBIAL COMPOSITION

INTRODUCTION AND OBJECTIVE:Sacral neuromodulation is an effective treatment for refractory overactive bladder. Based on standard culture, about 25% of explanted stimulators have been shown to be co...

Does a Recent Urinary Tract Infection Increase the Risk of Postprocedure Urinary Tract Infection After Onabotulinum Toxin A?

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27(2):121–125) Onabotulinum toxin A (BTX-A) is commonly used as treatment for refractory overactive bladder (OAB) but is associated with postprocedural urinary tract infection (UTI) in up to 35% of cases despite antibiotic prophylaxis. In women with recent UTI, it is unclear whether there should be a prolonged waiting period prior to BTX-A.

Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition).

The present article is an abridged English translation of the Japanese Clinical Guidelines for Female Lower Urinary Tract Symptoms (second edition), published in September 2019. These guidelines consist of a total of 212 pages and are unique worldwide in that they cover female lower urinary tract symptoms other than urinary incontinence. They contain two algorithms for "primary treatment" and "specialized treatment," respectively. These guidelines, consisting of six chapters, address a total of 26 clinical questions including: (i) treatment algorithms; (ii) what are female lower urinary tract symptoms?; (iii) epidemiology and quality of life; (iv) pathology and illness; (v) diagnosis; and (vi) treatment. When the patient's symptoms mainly involve voiding and post-micturition symptoms, specialized treatment should be considered. In the event of voiding symptoms concurrent with storage symptoms, residual urine should be measured; if the residual urine volume is <100mL, then diagnosis and treatment for storage symptoms is prioritized, and if the volume is ≥100mL, then specialized treatment should be considered. When storage symptoms are the primary condition, then the patient is subject to the primary treatment algorithm. Specialized treatment for refractory overactive bladder includes botulinum toxin injection and sacral nerve stimulation. For stress urinary incontinence, surgical treatment is indicated, such as urethral slings. The two causes of voiding symptoms and post-micturition symptoms are lower urinary tract obstruction and detrusor underactivity (underactive bladder). Mechanical lower urinary tract obstruction, such as pelvic organ prolapse, is expected to improve with surgery.

Efficacy and Safety of Sacral Neuromodulation in Treatment of Refractory Overactive Bladder

Background: Overactive bladder syndrome is a urinary disorder that occurs more frequently in women andolder people and is characterized by feeling an urge to urinate (sudden urge to urinate, with the feeling thatyou cannot get to the bathroom in time), doing it many times throughout the day (more than six) or havingepisodes of urinary incontinence (involuntary loss of urine) and nocturia (waking up several times duringthe night to urinate). In addition, other secondary symptoms may also occur, such as headache, dry mouth orblurred vision, among others. It is a problem that has a clear impact on the quality of life of those who sufferit and that can lead them to significantly reduce their social activity and negatively condition their work.Overactive bladder (OAB) is defined as urinary urgency with or without urgency urinary incontinence,nocturia, and/or frequency in the absence of UTI or other obvious pathology. Sacral neuromodulation is anewer surgical therapy for refractory OAB.Aim of Study: Is to assess the sacral neuromodulation (SN) safety and efficacy in refractory overactivebladder patients.Patients and Methods: In the period from November 2015 to May 2017. the unit of neurogenic bladderand neuromodulation in (Gazi Al_Harriry) surgical specialty hospital, medical city complex 27 patient agedfrom (17—55) year old were complaining from refractory overactive bladder. All the 27 patients underwentstage1 &amp; stage2 SNS devices implantation.Results: Patients of urgency incontinence (group1) demonstrated that the number of leak was significantlyreduced (p=0.01) after implantation of SN, (11.6_2.7) leak/day pre&amp; post SN, numbers of pads (6.9 _ 0.8)pad/day pre&amp;post SN. Patients with urgency frequency (group 2), numbers of voids/day pre &amp; post SNimplantation decreased significantly (p=0.01) (14.7 _ 6) voids /day. The voided volume increased significantly(p=0.02) from (136.4 _ 371.8) ml/void. The urgency episodes were decreased significantly (p=0.01) from(6.4 _ 2.1) episode/day. The complications occurred in 5 patients (18.5%). Two patients (7.4%) developedpain after trauma to the back, lead migration, lack of efficacy of device, treated by reprogramming thedevice, one patient (3.7%) get infection at the site of device implantation, SN was removed , there was onefemale patient (3.7%) got pregnancy and devise was deactivated. One patient (3.7%) complaining from painand discomfort at the device site was treated conservatively.Conclusion: Sacral neuromodulation is FDA approved as option for treatment of refractory OAB. There isexpanding of utilizing of SN in the past two decades. According to multiple studies in addition to our studyresults. The sacral neuromodulation is safe and efficacious treatment option for refractory OAB.

OnabotulinumtoxinA is a well tolerated and effective treatment for refractory overactive bladder in real-world practice

Introduction and hypothesisIn randomized clinical trials onabotulinumtoxinA was demonstrated to be an effective and well-tolerated treatment for overactive bladder (OAB) with urinary incontinence (UI). However, data reporting onabotulinumtoxinA use in everyday clinical practice are limited. Here, we present the results from a large, first-of-its-kind real-world study in patients with OAB.MethodsThis was a prospective, observational, multinational study (GRACE; ClinicalTrials.gov, NCT02161159) performed in four European countries. Patients (N = 504) aged ≥ 18 years with OAB inadequately managed with ≥ 1 anticholinergic received onabotulinumtoxinA per their physician’s normal clinical practice.ResultsPhysicians primarily used rigid cystoscopes for onabotulinumtoxinA injection; anesthesia/analgesia was utilized during most treatment procedures. Significant reductions in UI episodes/day from baseline to weeks 1 and 12 were observed as well as in micturition, urgency, and nocturia episodes/day. These improvements in urinary symptoms corresponded to higher scores on the treatment benefit scale at week 12. The use of other OAB medications dropped from baseline to weeks 1 and 12 and was sustained to week 52, which paralleled a reduction in the number of incontinence products used during that time frame. Adverse reactions were reported in 2.6% of patients throughout the study.ConclusionsIn this real-world study, significant improvements in urinary symptoms were seen following onabotulinumtoxinA treatment as early as week 1 and sustained to at least week 12. This was accompanied by a reduced reliance upon incontinence products and reduction in concomitant OAB medication use. OnabotulinumtoxinA was well tolerated with no new safety signals.

Botulinum toxin for overactive bladder

Idiopathic overactive bladder (OAB) is defined as asymptom complex characterized by urinary urgency with or without urinary incontinence, nycturia and increased frequency of micturition without the presence of an infection or other pathological conditions, especially a neurological disease. It is a diagnosis by exclusion. If conservative treatment with behavioral therapy and pelvic floor muscle training alone is not successful, pharmaceutical treatment is recommended according to the OAB staged treatment. For treatment refractory OAB, intravesical injection of onabotulinum toxinA is recommended according to the current guidelines (recommendation levelA). The approved dose is 100U botulinum toxin and is transurethrally injected into the detrusor muscle. The treatment effect lasts on average for 6-9 months and injections can be repeated without limitations. Due to the low rate of complications, the good success rate and the low invasiveness, botulinum toxin offers agood treatment option for treatment refractory OAB.

Treatment for refractory overactive bladder: a systematic review and meta-analysis of sacral neuromodulation and onabotulinumtoxinA.

This systematic review and meta-analysis aim to evaluate the outcomes between SNM and BTX in the treatment of refractory OAB. PubMed, Embase, and CENTRAL were comprehensively searched from their inception to December 2019. Randomized and nonrandomized controlled trials evaluating OAB patients who underwent SNM and BTX were included. Data extraction and quality assessment were conducted by two independent reviewers. The outcomes, side effects, and cost-effectiveness values of both procedures were compared in meta-analysis. This review involved six articles (2629 patients). Specifically, three articles were based on the same trial, and the other studies were retrospective cohort studies. No significant difference was found in successful treatment between BTX and SNM at 6months after procedures [risk ratio (RR) = 0.93, 95% confidence interval (CI) 0.63-1.39]. BTX exhibited a significantly higher total adverse event rate than SNM through 6months (RR = 1.55, 95% CI 1.28-1.88). Patients suffered more urinary tract infection (UTI) risk under BTX injection at the early stage (RR = 1.58, 95% CI 1.10-2.25); however, the difference in UTI events was not significant between the two groups (RR = 1.13, 95% CI 1.10-2.25) during the period of 7-12months postoperatively. Obviously, the short-term cost (1-2years) of BTX was significantly lower than that of the SNM procedure. Both treatments were effective; however, because of the high complication rate of BTX, it may not be a better way to treat refractory OAB than SNM, although BTX is more cost-effective for short-term treatment at present.

522 - Percutaneous tibial nerve stimulation versus sham efficacy in the treatment of refractory overactive bladder: Outcomes following a shortened 6-week protocol, a prospective randomized controlled trial

It is a prospective randomized controlled trial comparing the efficacy of percutaneous tibial nerve stimulation versus sham for a shortened 6-week protocol of treatment in management of refractory OAB in non-neurogenic adult patients. A total of 50 adults with refractory non-neurogenic overactive bladder symptoms were randomized 1:1 to 6 weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder symptom score as well as 3-day voiding diaries were completed at baseline and at 7th week, 3rd and 6th month. The 7th week, 3rd and 6th month symptom score assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation patients achieved statistically significant improvement in bladder symptoms with 52% reporting moderately improved responses compared to non-response of sham patients from baseline (P = 0.001). Voiding diary parameters after 6 weeks of therapy showed that PTNS patients had statistically significant improvements in frequency, voided volume and urgency urinary incontinence episodes compared to sham. No serious device-related adverse events or malfunctions were reported. A shortened 6-week treatment protocol with PTNS appears to be successful and more effective than sham in the treatment of refractory OAB. PTNS therapy is safe and effective in treating OAB symptoms with 52% success rate following a shortened 6-week protocol. The duration of treatment with PTNS can be halved compared to the conventional 12 weeks, which would make it more acceptable and cost effective for patients.

MP31-04 SHORTENED 6-WEEK PERCUTANEOUS TIBIAL NERVE STIMULATION FOR REFRACTORY OVERACTIVE BLADDER. A RANDOMISED CONTROLLED TRIAL

INTRODUCTION AND OBJECTIVE: Although the standard 12-weeks percutaneous tibial nerve stimulation (PTNS) for refractory overactive bladder (OAB) is effective, standard PTNS is costly. We aim to compare the efficacy of shortened PTNS versus sham for refractory OAB. METHODS: 57 non-neurogenic OAB adult patients were randomized to 6 weeks PTNS group or sham group. The PTNS group (25 patients) was treated with active PTNS, the sham group (25 patients) received a placebo treatment using a 34 gauge needle placed in the medial part of the gastrocnemius muscle. both groups had one session, lasted 30 minutes, performed 3 times weekly for 2 weeks. The primary outcome to assess symptoms improvements assessed by Homma and Blaivas OAB symptoms scores as well as 3-day voiding diaries at baseline, 7th week, 3rd, and 6th month. RESULTS: Patients baseline characteristics were comparable between groups (table 1). The 7th week, 3rd and 6th month OABSS demonstrated that PTNS achieved statistically significant improvement with 52% of patients reported voiding dairy (p <0.001) . Compared to sham group, the voiding dairy improved in patients with previous Botox with PTNS with p <0.001 (table 2). CONCLUSIONS: A shortened 6-week treatment protocol with PTNS appears to be successful and more effective than sham in the treatment of refractory OAB. 6-week treatment PTNS would make it more acceptable and cost effective for patients.Source of Funding: No