Tibial Nerve Stimulation: Recent Progress and Challenges.

PURPOSE OF REVIEW: This review examines the evolution, mechanisms of action, clinical efficacy, and future directions of tibial nerve stimulation (TNS) in the management of overactive bladder (OAB). We sought to clarify how percutaneous (PTNS), transcutaneous (TTNS), and implantable (ITNS) modalities compare in efficacy, safety, durability, and practical application relative to other advanced therapies. RECENT FINDINGS: Contemporary randomized trials, cohort studies, and meta-analyses demonstrate pooled response rates of approximately 60–80% across TNS modalities with meaningful improvements in urgency, frequency, nocturia, urgency urinary incontinence, and quality of life. TTNS shows comparable short-term efficacy to PTNS with practical advantages, and ITNS devices demonstrate durable outcomes and reduced treatment burden. Comparative data suggest non-inferior efficacy to sacral neuromodulation and onabotulinumtoxinA with favorable safety profiles. TNS represents an effective, minimally invasive neuromodulatory strategy for OAB. Implantable and closed-loop systems may further improve adherence and long-term outcomes, warranting continued head-to-head and parameter-optimization studies.