Neuromodulation versus medication for overactive bladder: the case for early intervention.

Overactive bladder (OAB) affects millions of people in the United States, and as the population ages, the prevalence of OAB will invariably increase. Conventional therapy for OAB includes behavioral modification and anticholinergic medication. OAB treatment comes with significant economic impact. With anticholinergic medications often resulting in significant adverse effects and treatment failures, neuromodulation offers an effective treatment modality that is durable and minimally invasive. We argue that neuromodulation, with its high rate of success and significant rate of patient satisfaction, should be offered early in the course of OAB treatment. In addition to sacral neuromodulation, tibial nerve stimulation and chemical neuromodulation offer effective alternative methods of neuromodulation. Neuromodulation is a well-established treatment for "refractory" OAB that deserves a place among traditional treatments for OAB.