Overactive Bladder (OAB) / Urgency Urinary Incontinence (UUI): Treatment Options
Patient Guide

Overactive Bladder (OAB) / Urgency Urinary Incontinence (UUI): Treatment Options

This page summarizes evidence‑based options for OAB/UUI. Decisions should be made with your clinician using shared decision‑making based on the 2024 AUA/SUFU guideline.1

Option What it is / How it’s done Best for Typical commitment Pros Things to watch
Bladder training & lifestyle Timed voiding, fluid/caffeine review, diet and activity; often paired with a bladder diary. Everyone as first step Daily habits; reassess in 4–8 weeks Lowest risk Low cost Needs consistency; benefits accrue over weeks.1
Pelvic floor muscle training (PFMT) Guided Kegels and urge‑suppression strategies, often with a pelvic health PT. Patients willing to practice exercises 6–12 weeks; refreshers later Improves urgency control; combines well with bladder training. Results vary; biofeedback adds little for idiopathic OAB.1
Oral medicines β3‑agonists (mirabegron, vibegron) or antimuscarinics (e.g., oxybutynin, solifenacin). Persistent symptoms after basics Daily pill; reassess ~4–8 weeks Proven vs placebo; similar efficacy across classes. Antimuscarinics: dry mouth/constipation and cognitive concerns. β3: monitor BP/HR.1
PTNS (office‑based tibial stimulation) Fine needle near the ankle; 30‑min electrical stimulation of tibial nerve (e.g., Urgent PC, NURO). When you prefer non‑drug therapy Weekly ×12, then maintenance (often monthly) Minimally invasive; low systemic effects. Requires visits; durability varies.1, 11, 12, 16
TTNS wearables (at home) Skin electrodes via sock/wrap or patch (e.g., Vivally®, ZIDA®) run prescribed sessions at home. Home therapy seekers Typically 30 min, 1–3×/week (varies by device) No needles; FDA‑cleared wearables exist. Evidence base growing; follow device IFU.7, 8, 9, 10
Implantable tibial stimulators Small device near the ankle. Options: Altaviva (auto‑therapy, 15 yr battery),eCoin (1-3 yr battery, auto‑therapy), Revi (battery‑free + wearable band during sessions) When meds/behavioral are inadequate or undesired Brief outpatient implant; periodic programming Home‑friendly therapy; no leads to the spine. MRI rules differ (e.g., eCoin: no MRI / keep lower leg out of bore); availability/coverage vary.3, 4, 5, 6, 17, 18
OnabotulinumtoxinA (“bladder Botox”) Cystoscopic injections in bladder wall (typical initial dose 100 U). Strong urgency/UUI after or instead of meds In‑office; repeat every ~3–12 months Often large symptom gains; dryness for many. UTI risk and temporary urinary retention requiring self‑catheterization for a minority.13, 19, 20
Sacral neuromodulation (SNM) Lead by sacral nerve + mini‑stimulator (Medtronic InterStim™, Axonics®); test phase before implant. Refractory OAB/UUI or mixed symptoms Trial week(s) → implant if effective Long‑term option; modern systems are MRI‑conditional for 1.5/3 T full‑body scans (under conditions). Surgical device; small risks of revision/lead migration.14, 15
Rare surgery Augmentation cystoplasty/diversion in severe refractory cases. Only when everything else fails Major surgery Last‑resort relief Higher complication risk; seldom needed for idiopathic OAB.1

Details by option

1) Bladder training & lifestyle

Start with low‑risk changes: scheduled voiding, trimming evening fluids and caffeine, and tracking patterns with a diary/app. The 2024 AUA/SUFU guideline recommends offering behavioral strategies to all appropriate patients and using shared decision‑making to mix and match with other therapies.1, 2

2) Pelvic floor muscle training (PFMT)

Pelvic health PT can teach coordinated contractions that suppress urgency. Combining PFMT with bladder training often helps; expect 6–12 weeks to gauge benefit. Biofeedback adds limited value for idiopathic OAB in most patients.1

3) Oral medicines

Two families are standard: β3‑agonists (mirabegron, vibegron) and antimuscarinics (oxybutynin, solifenacin, etc.). Across studies, average improvements are modest and broadly similar between classes. Discuss side effects (dry mouth, constipation and cognitive concerns with antimuscarinics; blood pressure/heart‑rate with β3) and align with your goals.1

4) Percutaneous tibial nerve stimulation (PTNS)

Office‑based stimulation via a fine needle by the ankle for 30 minutes. Typical protocol: weekly sessions for 12 weeks, then maintenance. Commercial systems include Urgent PC (Laborie) and NURO™ (Medtronic). Trials and real‑world data support symptom reductions for many patients.1, 11–16

5) Transcutaneous tibial nerve stimulation (TTNS) wearables

Non‑invasive, at‑home systems use stick‑on electrodes or a conductive sock to stimulate the tibial nerve. FDA‑cleared examples include Vivally® (Avation Medical) and ZIDA® (Exodus Innovations). Follow each device’s instructions for session frequency and safety.7–10

6) Implantable tibial stimulators

Altaviva™ (Medtronic)

Newly FDA‑approved (Sept 19, 2025) implantable tibial system with automatic therapy, ~15‑year battery life, MRI‑compatible per company announcement/labeling.17, 18

eCoin® (Valencia Technologies)

Implantable, automatic 30‑minute sessions on a fixed schedule (every 3–4 days). ~1-3 year battery life, MRI is conditional: the eCoin is considered MRI‑conditional when kept ≥20 cm outside the MRI bore; the lower leg should not be placed in the scanner bore.3, 4

Revi™ (BlueWind Medical)

Battery‑free implant; therapy is delivered when you wear a small ankle band during sessions. FDA De Novo granted in 2023 with MRI‑conditional labeling (see device manual for specific conditions).5, 6

7) OnabotulinumtoxinA (“bladder Botox”)

Injected into the bladder wall to calm urgency signals. Typical starting dose is 100 Units for idiopathic OAB; effects last months and injections are repeated. Benefits can be substantial, but there is a higher risk of UTI and a small risk of temporary urinary retention requiring intermittent self‑catheterization—discuss and plan ahead.13, 19, 20

8) Sacral neuromodulation (SNM)

A thin lead near the sacral nerves plus a mini‑stimulator (Medtronic InterStim™, Axonics®) modulates bladder signaling. A short externalized “test” predicts benefit before implantation. Modern systems support full‑body 1.5 T/3 T MRI under labeling conditions.14, 15

9) Rare surgical options

Bladder augmentation or urinary diversion is reserved for severe, refractory cases due to higher complication risk.1

This page is informational and not medical advice. Always discuss diagnosis, contraindications, MRI conditions, and device‑specific instructions with your clinician.

References

  1. Cameron AP, Suskind AM, et al. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. American Urological Association; 2024. PDF. Journal summary. [Accessed 2025]
  2. AUA/SUFU. Idiopathic Overactive Bladder: Algorithm Summary (2024). PDF.
  3. U.S. FDA. eCoin Peripheral Neurostimulator – P200036 (Approval summary). 2022. Link.
  4. Valencia Technologies. eCoin Peripheral Neurostimulator System — Patient Manual. P200036C; 2022. MRI note: device is MRI‑conditional when kept ≥20 cm outside MRI bore; do not place lower leg in bore. PDF.
  5. U.S. FDA. De Novo Decision Summary — Revi System (DEN220073). 2023. PDF.
  6. BlueWind Medical. Important Safety Information / MRI Conditional Labeling (Revi). 2023–2025. Link.
  7. U.S. FDA. Vivally System — 510(k) K220454. 2023. PDF.
  8. Avation Medical. Vivally® wearable at‑home treatment. 2023–2025. Link.
  9. U.S. FDA. ZIDA Wearable Neuromodulation System — 510(k) K192731. 2021. 510(k). PDF.
  10. ClinicalTrials.gov. Transcutaneous Tibial Nerve Stimulation: the ZIDA device. NCT04470765. Link.
  11. Laborie. Urgent PC® for Overactive Bladder (PTNS). 2024–2025. Link.
  12. Medtronic. Percutaneous Tibial Neuromodulation — NURO™. 2024–2025. Link.
  13. Cameron AP, et al. AUA/SUFU Guideline (J Urol summary). OnabotulinumtoxinA 100 U for idiopathic OAB. 2024. Link.
  14. Medtronic. MRI Information — Sacral Neuromodulation (InterStim™). 2020–2025. Link.
  15. Axonics. MRI Guidelines — Axonics SNM System (US). 2020–2024. PDF.
  16. Kobashi K, Margolis E, Sand P, et al. Prospective study of NURO™ PTNM in drug‑naïve OAB. J Urol. 2019. PubMed.
  17. Medtronic. Press release: FDA approval of Altaviva™ implantable tibial neuromodulation device. Sept 19, 2025. Link.
  18. Urology Times. FDA approves Altaviva™ for urge urinary incontinence. Sept 2025. Link.
  19. Allergan/AbbVie. BOTOX® prescribing information – Overactive Bladder. 2022–2024. PDF.
  20. Fala L. Botox (onabotulinumtoxinA) FDA approval for OAB; typical dose 100 U across 20 sites. Am Health Drug Benefits. 2014. Link.