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. 2025 Jan 21;19(2):110–116. doi: 10.1097/CU9.0000000000000266

Effectiveness of simultaneous electroacupuncture stimulation on the tibial and ilioinguinal-iliohypogastric nerves in the treatment of refractory overactive bladder syndrome in women

Tingting Lv a,∗, Weilin Fang a, Junwen Si b, Xiang Ji a, Ziwei Li a, Xin Song a, Jin Huang a, Zhijun Weng c,∗, Jianwei Lv a
PMCID: PMC12042199  PMID: 40314016

Abstract

Objectives

The aim of this study was to observe the clinical effectiveness of simultaneous electroacupuncture stimulation on the tibial nerve (TN) and ilioinguinal-iliohypogastric nerve (IIN/IHN) in the treatment of refractory overactive bladder (OAB) in women.

Materials and methods

A prospective study was conducted involving 94 female patients with a diagnosis of OAB in the Urology Department of our hospital from September 2022 to October 2023. The patients were randomly divided into a TN-IIN/IHN group and a control group, each comprising 47 cases. All patients in both groups had received anticholinergic muscarinic receptor antagonists (tolterodine/solifenacin), β3 receptor agonists, flupentixol/melitracen, and other basic treatment regimens with poor results. The TN-IIN/IHN group received simultaneous electroacupuncture on the TN and IIN/IHN, whereas the control group received pelvic floor muscle biofeedback electrical stimulation. Both groups underwent treatment 3 times a week for a total of 4 weeks. Bladder symptoms (24-hour voiding diary), OAB Symptom Score, OAB-Quality of Life Questionnaire, and anxiety and depression scores were compared and analyzed before treatment, after treatment, and at a 3-month follow-up. Clinical efficacy was also assessed.

Results

Both groups showed significant improvement in voiding frequency, nocturia, urgency, OAB Symptom Score, and average voiding volume after treatment and at follow-up (p < 0.01). The TN-IIN/IHN group showed significantly superior results compared with the control group (p < 0.01). Quality of life scores and anxiety and depression scores significantly decreased (p < 0.01), with the TN-IIN/IHN group scores significantly lower than those of the control group (p < 0.01). The treatment success rate in the TN-IIN/IHN group was 84.78%, whereas that in the control group was 28.89%, showing a statistically significant difference (p < 0.01). No significant adverse reactions occurred in either group during the treatment period.

Conclusions

Simultaneous electroacupuncture on the TN and IIN/IHN is effective in treating refractory OAB in women and has good long-term efficacy. This therapy is safe, convenient, and free of significant adverse reactions, providing a new approach for the clinical treatment of refractory OAB in these patients. It significantly improves bladder symptoms and alleviates anxiety and depression, thereby markedly enhancing the patients' quality of life.

Keywords: Electroacupuncture, Tibial nerve, Ilioinguinal-iliohypogastric nerve, Overactive bladder syndrome

1. Introduction

Overactive bladder (OAB) is a syndrome characterized by symptoms of urgency, often accompanied by increased frequency and nocturia, and may occur with or without urge urinary incontinence. The prevalence of OAB is relatively high, with an incidence rate of 12%–16% among adult women.[1,2] It is a common lower urinary tract disease that significantly impacts the quality of life of middle-aged and elderly women. In Asia, the prevalence among women older than 40 years is up to 22.1%,[3] and the incidence increases with age. Recurrent, refractory OAB imposes a heavy burden on patients' work and daily life, potentially leading to anxiety and depression.[3,4] Therefore, OAB in women needs to be adequately addressed. The pathogenesis of OAB is quite complex and involves multiple factors, making its clinical treatment rather challenging. Currently, the clinical management of OAB uses various therapies, including behavioral modifications, physical therapy, pharmacotherapy, and surgical treatments. Aside from behavioral therapy, oral medication remains the most widely used clinical treatment method, with the main drugs being muscarinic receptor antagonists and β3-adrenergic receptor agonists.[5,6] Although numerous studies have shown that pharmacotherapy can effectively alleviate symptoms such as urgency, frequency, and urge incontinence, some patients experience suboptimal effects and significant adverse reactions to medication, such as drowsiness, dry mouth, and constipation, which affect medication adherence.[7,8] Therefore, a considerable number of patients with OAB require alternative treatment methods. For patients who are unresponsive to or intolerant of pharmacotherapy, sacral nerve modulation, peripheral nerve modulation, and botulinum toxin injections can be used.[9]

Electrical nerve stimulation is an easy-to-use technology with autonomous control potential. Because of its minimally invasive approach, acceptability, reversibility, and positive outcomes, it has become an attractive option for OAB treatment. The main methods of electrical stimulation for this purpose are sacral neuromodulation and tibial nerve stimulation (TNS), both of which have been shown to be effective to some extent.[10] Sacral neuromodulation requires the surgical implantation of a sacral nerve stimulator, which may lead to surgical complications such as electrode breakage or displacement.[11] Initially, it was discovered that acupuncture at the “Sanyinjiao” acupoint improved urinary function. This point is located 4 finger-widths above the upper edge of the medial malleolus of the foot, with the tibial nerve (TN) situated deeper behind it. Researchers therefore hypothesized that stimulating the TN could affect urinary function. Stoller applied theories surrounding Chinese acupuncture points and improved TNS techniques to treat patients with urgency urinary incontinence and urgency and frequency syndrome. The results showed that 87% of patients experienced symptom improvement.[12] Animal experiments have shown that transcutaneous electrical nerve stimulation (TENS) can significantly improve detrusor muscle contraction and bladder filling sensation in experimental animals.[13] Sacral nerves exert their effects by stimulating the nerves corresponding to the spinal segments (S2–S3) of the bladder and urethra. The TN, being a branch of the sciatic nerve, contains nerve fibers from L4 to S3, making TNS an effective method to stimulate the targeted sacral nerve plexus.[14] Noninvasive percutaneous TNS (PTNS), a form of TENS, is considered nearly noninvasive and is well tolerated, with a success rate of 37%–82% for treating OAB.[15] It is reasonable to attempt PTNS when first-line treatments have failed and before considering surgical interventions. Research indicates that PTNS and invasive TNS show no significant difference in improving patient symptoms and quality of life.[16,17]

Bladder sensory information can be transmitted to the spinal cord via 2 pathways: the lumbar splanchnic nerves and the pelvic nerves. The cell bodies of the visceral sensory afferent pathways of the lumbar splanchnic nerves and pelvic nerves are located in the thoracolumbar (T13–L2) and lumbosacral (L6–S2) dorsal root ganglia (DRG), respectively.[18] The abdominal wall around the umbilicus is innervated by the thoracic segments, rostral lumbar segments, and iliohypogastric nerve (IHN).[19] These nerves, along with the parietal peritoneal afferent nerves, conduct signals to the DRG. The rostral lumbar DRG also house afferents from the bladder. The ilioinguinal-iliohypogastric nerve (IIN/IHN) under the abdominal wall forms 2 branches of the L1 spinal nerve. The impact of percutaneous abdominal wall stimulation of the IIN/IHN on bladder function may be attributed to the shared spinal innervation of the abdominal wall and bladder.[13,20] In addition, the urethral and bladder mucosa are richly supplied with nerve endings. Stimulation of the urethral and bladder mucosa reflexively causes muscle tension and spasms in the groin, pubic, and perineal areas, leading to discomforts such as distension, pain, and persistent urinary urgency.[21] The IIN/IHN block is widely used for anesthesia and postoperative analgesia in surgeries involving the groin area, scrotum, penile region, and pubic area.[21–23] Therefore, stimulation of the IIN/IHN has potential value in alleviating discomfort induced by urethral and bladder irritation.

This study combines the advantages of comprehensive neural regulation therapy and the minimally invasive, easy-to-use, and well-tolerated features of PTNS. It integrates traditional Chinese electroacupuncture techniques. On the basis of the positioning of the TN (including L4–S3 nerve fibers) and the IIN/IHN (converging from the T13–L2 spinal nerves), electrical acupuncture stimulation therapy was performed, yielding good clinical results. We hereby present the following report.

2. Materials and methods

Ninety-four female patients with OAB were recruited from the urology outpatient clinic at our hospital from September 2022 to October 2023. All patients had received basic treatment regimens, including anticholinergic muscarinic receptor antagonists (tolterodine/solifenacin), β3 receptor agonists (mirabegron), and antipsychotic drugs (flupentixol/melitracen), but the results were not satisfactory. Inclusion criteria were as follows: older than 18 years, diagnosis of primary OAB according to the International Continence Society criteria, bladder capacity > 100 mL, and voluntary participation in the trial with written informed consent. Exclusion criteria included pregnancy or lactation; secondary OAB symptoms, such as urinary tract obstruction; concurrent uncontrolled urinary tract infection within the past week; renal insufficiency with serum creatinine > 133 μmol/L; stable treatment through other methods; implanted neurostimulators, cardiac pacemakers, or defibrillators; malignant tumors or severe cardiovascular or cerebrovascular diseases; neurologic or psychiatric disorders; and other situations deemed inappropriate for participation by the investigators. This study was approved by the ethics committee of Shanghai Pudong New Area Gongli Hospital (approval no. 2020-KY-28).

3. Methods

3.1. Grouping method

Ninety-four patients meeting the previously mentioned criteria were randomly assigned into TN-IIN/IHN and control groups, with 47 patients in each group. General clinical data, including average age and disease duration, were compared through statistical analysis, and no significant differences were observed between the 2 groups (p > 0.05), as detailed in Table 1.

Table 1.

Comparison of general data before treatment in patients with OAB between the TN-IIN/IHN and control groups.

Category TN-IIN/IHN group, mean ± SD (n = 46) Control group, mean ± SD (n = 45) p
Age, yr 37.36 ± 15.28 37.68 ± 16.14 0.890
Postsurgery time, mo 21.52 ± 16.33 20.39 ± 18.51 0.758
OABSS, score 8.73 ± 1.81 8.84 ± 1.74 0.768
Bladder diary
 Frequency 12.86 ± 3.47 12.61 ± 2.92 0.711
 Urgent urination 3.78 ± 1.42 3.73 ± 1.39 0.867
 Nocturia 3.32 ± 1.85 3.24 ± 1.78 0.834
 UUI 3.56 ± 1.26 3.39 ± 1.31 0.529
Urine output, mL 152.37 ± 18.26 155.28 ± 19.45 0.464
OAB-q, score 57.64 ± 7.12 56.86 ± 7.44 0.611
SAS, score 43.37 ± 6.71 44.24 ± 6.35 0.527
SDS, score 44.45 ± 7.52 45.76 ± 6.08 0.368
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IIN/IHN = ilioinguinal-iliohypogastric nerve; OAB = overactive bladder; OAB-q = OAB-Quality of Life Questionnaire; OABSS = OAB Symptom Score; SAS = Self-Rating Anxiety Scale; SDS = Self-Rating Depression Scale; TN = tibial nerve; UUI = urge urinary incontinence.

Pretreatment within-group comparisons.

3.2. Treatment methods

Both patient groups controlled their daily water intake within the range of 1500 to 2000 mL, with an effort to evenly distribute the amount of water consumed. In addition, water intake was avoided in the 3 hours before bedtime, and beverages such as strong tea or coffee were avoided.

3.3. Instruments and equipment

Here are the devices used in our clinical trials.

1. Yindi KWD-808I Pulse Acupuncture Treatment Instrument (Changzhou Yingdi Electronic Medical Device Co, Ltd, Changzhou, China);

2. Acupuncture needles, diameter and length: 0.25 × 40 mm and 0.30 × 75 mm, respectively (Suzhou Medical Supplies Factory Co, Ltd, Suzhou, China);

3. PHENIX Neuromuscular Electrical Stimulation Therapy Apparatus (Electronic Concept Lignon Innovation, Montpellier, France).

3.4. Tibial nerve and ilioinguinal-iliohypogastric nerve group

Patients in the TN-IIN/IHN group received electroacupuncture treatment via simultaneous stimulation of the TN and IIN/IHN nerves. The specific method is discussed hereinafter.

3.4.1 Tibial nerve electroacupuncture stimulation

Patients were in a supine position, and 4 acupoints were selected based on the surface projection of the TN pathway. The upper 2 stimulation points (equivalent to the Sanyinjiao acupoint, SP6) are located 5 cm above the medial malleolar tip and close to the posterior margin of the medial tibia. The lower 2 stimulation points (equivalent to the Taixi acupoint, KI3) are located approximately 3 cm inside the medial tips of the bilateral medial malleolus. After disinfecting the skin with 75% alcohol, 0.30 × 50-mm sterile disposable acupuncture needles were used for direct insertion. The needle depth was between 20 and 40 mm. After insertion, the needles were connected to an electroacupuncture device. The positive electrode of the stimulator was connected to the acupuncture needle below, whereas the negative electrode was connected to the acupuncture needle above. The electrical stimulation parameters were set as follows: continuous wave, 2–2.5 Hz frequency, with the intensity adjusted based on the patient's comfort. Electroacupuncture treatment was administered 3 times a week, with each session lasting 60 minutes (Fig. 1).

Figure 1.

Figure 1

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Bilateral tibial nerve electroacupuncture stimulation. (A) Schematic diagram illustrating the distribution and course of the tibial nerve, along with the localization of acupuncture points (including Sanyinjiao and Taixi acupoints, 4 needles at the ankle), for administration of electroacupuncture. (B) The lower limbs of a patient with overactive bladder undergoing tibial nerve electroacupuncture stimulation. The state of the electroacupuncture device after the needles are inserted into the acupuncture points is shown. The needles are connected to an electroacupuncture device. The positive electrode of the stimulator is connected to the acupuncture needle below, whereas the negative electrode is connected to the acupuncture needle above.

3.4.2 Ilioinguinal-iliohypogastric nerve electroacupuncture stimulation

Patients were in a supine position. On the basis of the course of the IIN/IHN, 4 acupoints were chosen in the lower abdomen (Fig. 2). The 2 lower stimulation points were located 1 cm above the pubic tubercles on both sides. The needle (0.35 × 75 mm) was inserted obliquely, downward toward the midline, 3–5 cm (tilted at an angle of approximately 45 degrees), with the needle tip touching the nerve nearby (IHN). Patients felt an electric current directed toward the urethra. The 2 upper stimulation points were located 4 cm above and 1 cm lateral to the lower points. Similarly, a needle was obliquely inserted to a depth of approximately 3 cm, and the needle tip touched the nerve (ilioinguinal nerve), leading to the sensation of electric current directed toward the urethra. The electroacupuncture apparatus was connected, with each pair of electrodes connecting acupuncture needles on the same side of the body. The positive electrode was connected to the upper 2 acupoints, and the negative electrode was connected to the lower 2 acupoints. The electrical stimulation parameters were set as follows: continuous wave, 2–2.5 Hz, each session lasting 60 minutes, with intensity adjusted to the patient's comfort level. During each treatment session, both TN and IIN/IHN electroacupuncture stimulation was applied simultaneously.

Figure 2.

Figure 2

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Bilateral ilioinguinal-iliohypogastric nerve (IIN/IHN) electroacupuncture stimulation. (A) Schematic diagram depicting the anatomical distribution of the IIN/IHN in the abdominal wall. (B) Selected abdominal skin stimulation points for the 4 abdominal needles, distributed symmetrically, with 2 on each side. The upper point corresponds to the stimulation point for the IIN, and the lower point corresponds to the stimulation point for the IHN. (C) The abdominal appearance of patients with overactive bladder after acupuncture needle insertion. (D) Acupuncture needles connected to the electroacupuncture device with the stimulating electrodes, with the upper, black clamp serving as the negative (−) pole and the lower, yellow clamp serving as the positive (+) pole. Simultaneously conducted with tibial nerve stimulation.

3.5. Control group

Patients in the control group received treatment with combined transcutaneous electrical stimulation (not electroacupuncture, but TENS) of the peroneal nerve and pelvic floor muscle electrical stimulation. The pelvic floor electrical stimulation procedure involved having the patient lie supine after emptying the bladder, ensuring mental relaxation. Sterilized electrodes were inserted into the vagina until the distal end of the electrode neck was in place. The electrodes were connected to the neuromuscular electrical stimulation device (PHENIX series). The treatment included vaginal electrical stimulation combined with biofeedback training. The frequency was set low (12.5–30 Hz), with each electrical stimulation session lasting 40 minutes and biofeedback training lasting 20 minutes, totaling 60 minutes of treatment. The current intensity started at 0 mA and increased in increments of 5% until the patient felt a sensation without significant discomfort, generally not exceeding 60 mA. All patients wore a smart transcutaneous TNS device during treatment, receiving 30 minutes of unilateral TNS. The stimulation frequency was set at 20 Hz with a pulse width of 200 μs. The intensity of the stimulation was adjusted to elicit a twitch in the patient's big toe without causing any discomfort. Both groups of patients underwent treatment 3 times a week, with 1 day off between sessions, for a total of 12 treatments (4 weeks).

3.6. Improvement indicators

3.6.1 Primary efficacy assessment indicators

The treatment success rate was calculated based on changes in the Overactive Bladder Symptom Score (OABSS) before and after treatment, where the treatment success rate = clinical cure + clinical improvement + clinical efficacy.[4] Clinical cure was defined as a reduction in OABSS by 90% or more compared with before treatment, with stable condition during a 3-month follow-up. Clinical improvement was defined as a reduction in OABSS by 75% or more but less than 90%, with stable condition during a 3-month follow-up. Clinical efficacy was defined as a reduction in OABSS by 50% or more but less than 75%, with stable condition during a 3-month follow-up. Mild clinical improvement was defined as a reduction in OABSS by 25% or more but less than 50%. Clinical inefficacy was defined as a reduction in OABSS by less than 25%.

3.6.2 Secondary quantitative indicators

The following indicators were recorded before treatment, at the end of treatment (4 weeks), and during follow-up (3 months): OABSS, 24-hour voiding diary (including voiding frequency, nocturia frequency, urgency frequency, average voided volume, and urgency urinary incontinence episodes), Overactive Bladder-Quality of Life Questionnaire Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS).

Baseline assessments were conducted for all patients before treatment, and treatment efficacy assessments, as well as assessments using questionnaires, were recorded by assessors not involved in the treatment.

3.7. Statistical methods

Data analysis was performed using SPSS software. Descriptive statistics (mean ± standard deviation) were used for normally distributed continuous data, with between-group comparisons conducted using independent t tests and within-group comparisons using paired t tests. For nonnormally distributed continuous data, the median (Q1, Q3) was used for description, and the Wilcoxon rank-sum test was used for between-group comparisons. Frequency and composition ratio were used for categorical data description, and between-group comparisons were conducted using the χ2 test or Fisher exact test. A level of p < 0.05 was considered statistically significant.

4. Results

4.1. Comparison of general data before treatment

A total of 94 patients were included in this study, with 47 in each group. Two patients withdrew from the trial because of non–disease-related factors (1 from each group). In the control group, 1 patient was unable to complete the treatment course and withdrew from the trial. A total of 91 patients were included in the final analysis, with 46 in the TN-IIN/IHN group and 45 in the control group. There were no statistically significant differences in age; duration of illness; the number of voids, urgency episodes, nocturnal voids, and urgency urinary incontinence episodes; and average voided volume, OABSS, or quality of life scores (SAS, SDS) before treatment between the 2 groups (p > 0.05; Table 1).

4.2. Comparison of symptomatic quantitative indices after treatment

After the treatment and 3-month follow-up, various indicators were compared with the baseline before treatment in both groups. The OABSS of patients in both groups significantly decreased (p < 0.01). The 24-hour frequency of urination, urgency episodes, nocturnal voids, and episodes of urgency urinary incontinence in both groups showed a significant decrease (p < 0.01), whereas the average voided volume per micturition significantly increased (p < 0.01). When compared with the control group, the TN-IIN/IHN group exhibited a more pronounced reduction in 24-hour frequency of urination, urgency episodes, nocturia, OABSS, and SAS and SDS scores related to quality of life both posttreatment and during follow-up (p < 0.01). The increase in voided volume was also more significant (p < 0.01) (Table 2).

Table 2.

Comparison of posttreatment symptomatic quantitative indices between the TN-IIN/IHN and control groups.

Category TN-IIN/IHN group, mean ± SD (n = 46) Control group, mean ± SD (n = 45) p
OABSS change, score
 Fourth week −4.39 ± 1.26 −2.17 ± 1.50 <0.01*
 3-mo FU −4.22 ± 1.09 −1.75 ± 1.22 <0.01*
Frequency change
 Fourth week −4.82 ± 1.04 −2.27 ± 1.62 <0.01*
 3-mo FU −4.53 ± 1.21 −1.96 ± 1.38 <0.01*
Urgent urination change
 Fourth week −1.71 ± 0.63 −0.78 ± 0.24 <0.01*
 3-mo FU −1.65 ± 0.75 −0.62 ± 0.17 <0.01*
Nocturia change
 Fourth week −1.46 ± 0.52 −0.64 ± 0.35 <0.01*
 3-mo FU −1.42 ± 0.71 −0.57 ± 0.68 <0.01*
UUI change
 Fourth week −1.55 ± 0.57 −0.62 ± 0.26 <0.01*
 3-mo FU −1.42 ± 0.63 −0.53 ± 0.11 <0.01*
Urine output change, mL
 Fourth week 102.90 ± 15.69 45.19 ± 11.77 <0.01*
 3-mo FU 98.66 ± 14.82 36.02 ± 10.21 <0.01*
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FU = follow-up; IIN/IHN = ilioinguinal-iliohypogastric nerve; OABSS = Overactive Bladder Symptom Score; TN = tibial nerve; UUI = urge urinary incontinence.

Pretreatment within-group comparisons, *p < 0.05.

4.3. Comparison of therapeutic efficacy and quality of life indicators after treatment between the 2 groups

The treatment success rate in the TN-IIN/IHN group was 84.78% (39/46), whereas that in the control group was 28.89% (13/45), showing a statistically significant difference (p < 0.01). At the end of the treatment and follow-up, the quality of life and anxiety and depression levels of both groups improved significantly compared with before treatment (p < 0.01). However, the improvement in the TN-IIN/IHN group was more significant than that in the control group (p < 0.01) (Table 3). No adverse reactions such as infection, hematoma, difficulty in urination, or pain were observed in any of the patients after treatment.

Table 3.

Comparison of therapeutic efficacy and quality of life indicators after treatment between the TN-IIN/IHN and control groups.

Category TN-IIN/IHN group, mean ± SD
(n = 46)		 Control group, mean ± SD
(n = 45)		 p
Total effectiveness after 3-mo FU, n (%)
 Improvement 39 (84.78) 13 (28.89) <0.01
  – Cured/significant effect 15 2
  – Effective 24 11
 Minor effect 4 17
 Ineffective 3 15
OAB-q change, score
 Fourth week −29.25 ± 5.93 −7.53 ± 5.57 <0.01*
 3-mo FU −28.32 ± 6.05 −5.69 ± 6.16 <0.01*
SAS change, score
 Fourth week −24.46 ± 3.51 −4.46 ± 2.83 <0.01*
 3-mo FU −22.85 ± 3.11 −3.29 ± 2.88 <0.01*
SDS change, score
 Fourth week −26.67 ± 3.92 −3.54 ± 2.75 <0.01*
 3-mo FU −25.05 ± 4.18 −3.26 ± 2.95 <0.01*
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FU = follow-up; IIN/IHN = ilioinguinal-iliohypogastric nerve; OAB-q = Overactive Bladder-Quality of Life Questionnaire; TN = tibial nerve; SAS = Self-Rating Anxiety Scale; SDS = Self-Rating Depression Scale;

Compared with intragroup treatment, *p < 0.05.

5. Discussion

This study used acupuncture needles, composed of fine and elastic stainless steel, as a tool for low-frequency electrical pulse stimulation. These needles serve as effective conductors for low-frequency stimulation, allowing direct transmission of electrical impulses to the TN region and fibers of the IIN/IHN. The results of this study confirm the significant clinical efficacy of simultaneous electroacupuncture stimulation on the TN and IIN/IHN in treating refractory OAB in women. The treatment success rate in the TN-IIN/IHN group was 84.78%, significantly higher than the control group's 28.89%, and the treatment demonstrated good short-term efficacy. The approach significantly improved urination frequency, urgency, nocturia, urinary incontinence, (increased) urine volume, quality of life, and anxiety and depression symptoms compared with the control group. Although the control group also showed improvements in posttreatment urination frequency, nocturia, and quality of life scores, these improvements could be associated with behavioral therapy, psychological self-regulation, psychological suggestion, or the “placebo” effect. The entire treatment process demonstrated good safety, with no occurrence of serious adverse events.

5.1. Four ankle needles

This technique involves needling the TN above the ankle joint, which includes nerve fibers from L4 to S3. These nerve fibers originate from the same spinal segments that supply the bladder and pelvic floor. The mechanism of action involves stimulating the somatic afferent components about 5 cm above the medial malleolus to inhibit afferent activity from the bladder, thereby blocking the transmission of abnormal sensations to the spinal cord and brain. It inhibits the sensory transmission to the pontine micturition center via intermediate neurons and directly inhibits the sacral parasympathetic preganglionic neurons in the efferent pathway. In addition, it can suppress the bladder-urethra reflex and close the bladder neck. This mechanism prevents involuntary urination (reflex urination) without inhibiting voluntary urination, thus affecting and regulating the behavior of effector organs such as the bladder, urethral sphincter, and pelvic floor, which are innervated by the sacral nerves. This neuromodulation technique is used to treat OAB.[24]

5.2. Four abdominal needles

This technique involves acupuncture of the IIN/IHN nerve fiber endings, both originating from the L1 nerve root of the lumbar plexus. These nerves share the same spinal segments as the lower hypogastric sympathetic plexus (T13–L2), which innervates the bladder and pelvic floor. The mechanism of action involves low-frequency pulsed electroacupuncture, during which these stimulation signals converge at the L1 spinal segment nerve center. The low-frequency pulsed signals may regulate sympathetic nerve activity in the T13–L2 segments, thereby inhibiting central sensitization and abnormal nerve conduction at the spinal segment level. This can reduce hypersensitivity of the bladder and urethra, alleviating discomfort and pain associated with OAB.[18]

The combination of these 2 approaches achieves “neural regulation” of the sympathetic and parasympathetic nervous systems through different pathways. Sympathetic nerve regulation (via the 4 abdominal needles) inhibits the bladder's sensory hypersensitivity and hyperactivity, increases bladder capacity, enhances urine storage capability, and reduces the frequency of the urge to urinate. Parasympathetic nerve regulation (via the 4 ankle needles) reduces involuntary contractions of the detrusor muscle and decreases the frequency and intensity of the urination reflex. Together, these effects significantly improve the symptoms of patients with OAB and enhance their quality of life. This treatment method has significant clinical application potential and is worthy of further research and promotion.

This study included a small number of cases and had a short follow-up period. Despite some limitations, results of the study by Peters et al.[25] confirmed that most patients with OAB who received PTNS for 12 weeks can safely maintain improved OAB symptoms for 3 years with an average of 1 treatment per month. Bianchi et al.[26] evaluated “real-life” data in a 7-year follow-up after successful PTNS treatment for OAB or nonobstructive voiding dysfunction. The study results showed that most patients who responded to PTNS still perceived improvement during the 7-year follow-up.

6. Conclusions

The electroacupuncture therapy used in this study integrates the theories of neuromuscular anatomy, low-frequency electrical stimulation, and traditional Chinese acupuncture, providing an innovative and convenient treatment method that is both safe and effective. By adjusting electroacupuncture parameters (such as frequency, intensity, and treatment duration) according to individual patient conditions, personalized treatment plans are formulated. This approach demonstrates high levels of safety and patient tolerability. Our research possesses a novel advantage by combining TN stimulation with stimulation of the IIN/IHN, engaging both the sympathetic and parasympathetic nervous systems in a “dual neural modulation” strategy, thereby maximizing their synergistic effects and achieving greater clinical benefits. It is suitable as part of long-term management for OAB and can be combined with other treatment modalities such as medication or behavioral therapy to further enhance efficacy.

Acknowledgments

None.

Statement of ethics

This study was approved by the Ethics Committee of Shanghai Pudong New Area Gongli Hospital (approval no. 2020-KY-28). All participants provided written informed consent. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Funding source

This study was sponsored by the Shanghai Pudong New Area High-level Discipline Construction Clinical Medicine New Quality Specialty (2024-PWXZ-13), the Top-Level Clinical Discipline Project of Shanghai Pudong (PYWgf2021-06), and the Demonstration Pilot Project of Traditional Chinese Medicine Inheritance and Innovation Development in Pudong New Area: The Construction Plan of the Flagship Department of Chinese and Western Medicine Collaboration (Urology) in Pudong New Area (YC-2023-0405).

Author contributions

TTL, WLF: Writing the initial draft of the article;

JWL, ZJW: Reviewing and revising the article;

JWL, ZJW: Research design and protocol development;

WLF, XS: Clinical data collection and analysis;

JWS, ZWL, JH: Patient recruitment;

TTL, JWS, XJ: Clinical treatment procedures.

Footnotes

How to cite this article: Lv T, Fang W, Si J, Ji X, Li Z, Song X, Huang J, Weng Z, Lv J. Effectiveness of simultaneous electroacupuncture stimulation on the tibial and ilioinguinal-iliohypogastric nerves in the treatment of refractory overactive bladder syndrome in women. Curr Urol 2025;19(2):110–116. doi: 10.1097/CU9.0000000000000266

Contributor Information

Weilin Fang, Email: hereforever@126.com.

Junwen Si, Email: sjw80@163.com.

Xiang Ji, Email: jx08701@glhospital.com.

Ziwei Li, Email: 1052341387@qq.com.

Xin Song, Email: songxin19891014@163.com.

Jin Huang, Email: 734409095@qq.com.

Jianwei Lv, Email: ljwass2020@163.com.

Conflict of interest statement

The authors declare no conflict of interest.

Data availability

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

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