***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation ( TTNS ) to treat urge urinary incontinence ( UUI ) in older women . Material and methods The study design was a r and omized clinical trial conducted on 51 elderly women ( > 60 years ) with UUI . All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises , and 25 were r and omly selected to receive TTNS in addition to the st and ard therapy . The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary , quality of life question naires ( QoL ) , and subjective response . Results Of the patients , 68.0 % in TTNS group reported cure or improvement vs. 34.6 % in the control group ( P = 0.017 ) . TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group . Conclusion TTNS is efficacious to treat UUI in older women Objective To verify whether the combination of transcutaneous electrical neural stimulation ( TENS ) with oxybutynin in the treatment of women with overactive bladder ( OAB ) would be more effective than isolated treatments . Methods We r and omized 75 women with OAB , in three groups : GI—30 min TENS , twice a week ; GII — daily slow release 10 mg oxybutynin ; and GIII — TENS + oxybutynin ( multimodal ) ; all for 12 weeks . Patients were evaluated with vali date d question naires International Consultation on Incontinence-Short Form ( ICIQ-SF ) , International Consultation on Incontinence-OAB ( ICIQ-OAB ) , Symptom bother , and 3-day Voiding diary at weeks 0 , 12 , and 24 . Results The groups were similar before treatment . After treatment , all groups significantly improved in OAB symptoms and quality of life ( QoL ) . At week 12 , ICIQ-OAB scores were 5.9 , 4.6 , and 2.9 , in groups I , II , and III , respectively , p = 0.01 . At week 24 , GI and GIII kept the scores of the end of treatment ( week 12 ) , while GII increased ICIQ-OAB from 4.6 to 9.2 , p = 0.0001 , ICIQ-SF from 9.8 to 13.3 , p = 0.0006 , and Symptom bother score from 3.4 to 7.0 , p = 0.0001 . Conclusions The multimodal treatment was more effective and TENS alone or in association presented longer lasting results for improvement of clinical symptoms of OAB and Purpose To compare the effectiveness of percutaneous tibial nerve stimulation ( PTNS ) using adhesive skin surface electrodes versus solifenacin succinate ( SS ) in patients with neurogenic detrusor overactivity ( NDO ) secondary to spinal cord injury ( SCI ) . Methods A r and omized controlled study involving 100 patients with NDO secondary to SCI was conducted . Patients were r and omized into two groups . In group A , patients received PTNS using adhesive skin surface electrodes for 4 weeks . In group B , patients underwent SS treatment for 4 weeks . Bladder diaries and incontinence quality of life question naire were review ed before treatment and 2 and 4 weeks after treatment . Results Improvement in all bladder diary parameters was statistically significant within each group 2 and 4 weeks after treatment compared to baseline ( p < 0.05 ) , but did not reach statistical significance between the PTNS and SS groups ( p > 0.05 ) . Compared to SS , PTNS was not associated with any unanticipated adverse events . Conclusions PTNS therapy with adhesive skin surface electrodes is an effective method to treat NDO secondary to SCI . This therapy is not only no difference comparing to SS therapy but also noninvasive and easily managed by patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIMS This is the first study design ed to describe the natural history of stress urinary incontinence ( SUI ) and overactive bladder ( OAB ) , using vali date d symptom syndrome severity scores developed for the purpose . METHODS Two separate but related studies were involved , ( i ) a clinic sample ( N = 2,052 ) from a r and omised controlled trial ( RCT ) and ( ii ) a prospect i ve cohort study ( N = 12,750 ) with 3-year follow-up . Subjects in both studies were women aged 40 or more living in the community , approached using similar postal question naires .  Severity scores using st and ardised urinary symptoms were derived for SUI and OAB from weightings obtained from logistic regression models of symptoms in relation to urodynamic diagnosis . Symptom severity scores were plotted for baseline and 3 years of follow-up to demonstrate the natural history of the main categories of SUI and OAB . RESULTS Overactive bladder and SUI syndrome severity scores showed good criterion validity in relation to relevant clinical measures and good test-retest reliability . OAB severity increased progressively with age including a period of accelerated increase in the 60s . In contrast , SUI severity showed two age-related peaks around age 60 and again at age 80 . SUI severity also showed a more fluctuating pattern from year to year compared to OAB . CONCLUSIONS Contrasting patterns of natural history for OAB and SUI syndromes were identified consistent with differences in the patterns of related co-morbidities . Further studies are needed to confirm these findings Objective : Overactive bladder ( OAB ) is characterized by symptoms of urinary frequency and urgency , with and without incontinence , and has been shown to have significant impact on health-related quality of life ( HRQL ) . Currently , no OAB-specific question naires exist to evaluate all symptoms of OAB ; thus we sought to evaluate the psychometric properties of a newly developed OAB HRQL question naire . Methods : The 33-item , self-administered OAB-q contains a symptom bother and HRQL scale . Both the OAB-q and SF-36 were completed by participants from two sources : ( 1 ) a community sample who screened positive for OAB in a r and om-digit dial telephone survey and participated in a clinical validation study ( n = 254 ) ; and ( 2 ) a clinical study of patients ' seeking treatment for OAB symptoms ( baseline assessment ) ( n = 736 ) . Item and exploratory factor analysis were performed to assess the subscale structure of the question naire . Psychometric evaluation was conducted to assess reliability and validity . Results : Seventy-four percent of the sample were women with mean age of 58.5 . Participants with continent and incontinent symptoms reported significantly greater symptom bother and HRQL impact than normal participants . Significant differences were present among all patient groups in all OAB-q subscales ( p < 0.0001 ) except sleep where the impact of continent and incontinent OAB was similar , but significantly worse than normal participants ( p < 0.0001 ) . Internal consistency was high with the subscale Cronbach α-values ranging from 0.86 to 0.94 . Conclusion : The OAB-q is a reliable and valid instrument that discriminates between normal and clinical ly diagnosed continent and incontinent OAB participants . The OAB-q demonstrates that both continent and incontinent OAB symptoms cause significant symptom bother and have a negative impact on HRQL INTRODUCTION AND HYPOTHESIS The aim of this study was to evaluate the effectiveness of transcutaneous posterior tibial nerve stimulation ( T.C. PTNS ) versus extended release oxybutynin ( E.R.O. ) in patients with overactive bladder . MATERIAL S AND METHODS Seventy female patients were r and omized to receive either 10 mg E.R.O. daily or T.C. PTNS , using a TENS machine program with the 20Hz , 200 cycles/s , and normal stimulation setting for two 30-min sessions , each week for a 12-week period . Pre-treatment and after the 12-week intervention , each patient completed a 3-day voiding diary and a  self-report quality of life question naire ( OAB-q ) . Statistical analysis was performed using Stata V12.1 . RESULTS Sixty-four patients completed the treatment protocol . There were no significant differences between study groups in terms of age , body mass index , past hormone replacement therapy , smoking habits , menopause status , and parity . Prior to treatment , there were also no significant differences in the analysis of the 3-day voiding diary or in the OAB-q question naire results . Following the 12-week study , there was a statistically significant reduction in frequency of urination , urgency episodes , and urge incontinent episodes compared to pre-treatment values . However , there were no significant differences in these values between intervention groups after 12-weeks of therapy . There was a similar improvement in OAB-q scores in both treatment groups following therapy , and the T.C. PTNS group showed a statistically significant improvement over the E.R.O. in domain 2 of the OAB-q question naire . The other two domains showed similar improvement in both study groups . CONCLUSION T.C. PTNS and E.R.O. demonstrated similar improvements in subjects with OAB in a 12-week study Background No study has compared the bothersomeness of all lower urinary tract symptoms ( LUTS ) using a population -based sample of adults . Despite this lack of evidence , investigators have often cited their LUTS of interest as the “ most bothersome ” or “ one of the most bothersome . ” Objective To compare the population - and individual-level burden of LUTS in men and women . Design , setting , and participants In this population -based cross-sectional study , question naires were mailed to 6000 individuals ( 18–79 yr of age ) r and omly identified from the Finnish Population Register . Outcome measurements and statistical analysis The vali date d Danish Prostatic Symptom Score question naire was used for assessment of bother of 12 different LUTS . The age-st and ardized prevalence of at least moderate bother was calculated for each symptom ( population -level burden ) . Among symptomatic individuals , the proportion of affected individuals with at least moderate bother was calculated for each symptom ( individual-level bother ) . Results and limitations A total of 3727 individuals ( 62.4 % ) participated ( 53.7 % female ) . The LUTS with the greatest population -level burden were urgency ( 7.9 % with at least moderate bother ) , stress urinary incontinence ( SUI ) ( 6.5 % ) , nocturia ( 6.0 % ) , postmicturition dribble ( 5.8 % ) , and urgency urinary incontinence ( UUI ) ( 5.0 % ) . Burden from incontinence symptoms was higher in women than men , and the opposite was true for voiding and postmicturition symptoms . At the individual level , UUI was the most bothersome for both genders . Although the response proportion was high , approximately a third did not participate . Conclusions Both men and women with UUI report moderate or major bother more frequently than individuals with other LUTS . At the population level , the most prevalent bothersome symptoms are urgency , SUI , and nocturia . Patient summary Urinary urgency was the most common troubling symptom in a large population -based study ; however , for individuals , urgency incontinence was the most likely to be rated as bothersome Introduction and hypothesisThis study evaluated the efficacy and tolerability of transcutaneous posterior tibial nerve stimulation ( TPTNS ) in the treatment of overactive bladder ( OAB ) after failure of a first-line anticholinergic treatment . Material s and methods We performed a prospect i ve observational study and included all patients treated in a single center for OAB persisting after first-line anticholinergic treatment from November 2010 to May 2013 . The protocol consisted of daily stimulation at home . The efficacy end point was defined as improvement on the Urinary Symptom Profile ( USP ) and the French-vali date d urinary symptom score Mesure du H and icap Urinaire ( MHU ) . Results We assessed 43 consecutive patients . TPTNS was successful following 1 month of treatment in 23 ( 53 % ) patients . Bladder capacity was the only predictive factor for treatment success ( p = 0.044 ) . For patients who showed improved symptoms ( n = 23 ; 53 % ) , mean MHU and USP decreased significantly , from 11.8 ± 2.8 to 5.6 ± 3 ( p < 0.001 ) and from 14 ± 3.3 to 6.9 ± 3.2 ( p < 0.001 ) , respectively . After a mean follow-up of 10.8 ± 1.6 months , 21 ( 49 % ) patients continued the TPTNS . Mean MHU and USP scores were 4.4 ± 2.8 and 5.4 ± 3.5 , respectively , and stayed lower than baseline ( p < 0.001 ) . Patients reported no adverse events . Conclusion TPTNS is well tolerated and is effective in one half of the patients studied after they failed anticholinergic treatment . TPTNS could become a second therapeutic option before surgical treatment in the management strategy of OAB AIMS To determine whether changes in question naire scores on symptoms and condition-specific quality of life reflect clinical ly relevant improvements in women with stress urinary incontinence ( SUI ) . METHODS We retrospectively analyzed question naires collected during a r and omized controlled trial in women with SUI , that received pelvic floor muscle training ( PFMT ) 
    Output:
    
Limited evidence is provided that TTNS is an effective , safe intervention for idiopathic OAB in adults and may be of benefit in those with neurogenic OAB .