Refractory Overactive Bladder (ROAB) Treatment

Patients who fail or are intolerant to conservative and oral therapies are considered to have refractory overactive bladder (ROAB). Historically these patients have had few options but in the last decade, new therapies like injections and nerve stimulation have become available.


Botox (onabotulinumtoxinA) for the Bladder

In 2013, the FDA approved onabotulinumtoxinA (Botox) bladder injections for patients with refractory overactive bladder. Botox blocks nerve signals in the bladder muscle reducing ROAB symptoms. Botox injections are performed in the office setting under local anesthesia or in an outpatient surgery center with sedation.  Side effects can include pain with urination, urinary tract infection, or difficulty urinating requiring the temporary use of a catheter.

Nerve Stimulation

Percutaneous Tibial Nerve Stimulation (PTNS)

Approved in 2010 by the FDA, PTNS is an office-based procedure indirectly targeting the nerves to the bladder and pelvic floor. This is a low-risk therapy available to almost every patient.  Therapy involves the placement of a thin needle electrode into the ankle. During a thirty-minute treatment, the needle stimulates the nerves in the pelvis with mild electrical impulses. This process of neuromodulation results in an improvement in ROAB symptoms.

Sacral Nerve Stimulation (SNS)

Sacral nerve stimulation was FDA-approved in 2007. This effective treatment necessitates the implantation of a metal device (neurotransmitter) in the buttock to directly stimulate the sacral nerve plexus. Through this neurotransmitter, electrical impulses are sent directly to the sacral nerves. The sacral nerves provide intervention to the bladder and thus the impulses aid in symptom reduction for patients with ROAB.


Urologic Surgeons of Washington is a proud member of Privia Medical Group. The best doctors in our community have joined together to form Privia Medical Group (PMG), a multi-specialty, high-performance medical group that puts patients first. Our physicians are united by the mission of providing better, more coordinated care for their patients.

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