Overactive bladder is a condition characterized by a sudden and difficult-to-control need to urinate, which may occur with frequent urination, nighttime urination, and urine leakage. Some women continue to experience these symptoms despite lifestyle changes, behavioral therapy, and medication, or they cannot tolerate or decline medical treatment.
This study will evaluate whether low-intensity extracorporeal shock wave therapy (Li-ESWT), a non-surgical treatment delivered externally over the lower abdomen, can safely improve refractory overactive bladder symptoms in women.
A total of 40 women will be randomly assigned in equal numbers to receive either active Li-ESWT or a sham treatment. Both groups will attend one treatment session each week for six weeks. The sham procedure will be similar to the active treatment in positioning, session duration, and device sound but will not deliver shock wave energy.
Symptoms will be assessed using the validated Arabic version of the 8-item Overactive Bladder Questionnaire (OAB-V8) before treatment and during follow-up. The main purpose of the study is to compare the change in OAB-V8 symptom score between the two groups after one month. Additional assessments at three months will include post-void residual urine volume, information from a 3-day voiding diary, the participant's overall impression of improvement, and any treatment-related adverse events.
The study hypothesis is that Li-ESWT will improve overactive bladder symptoms and quality of life compared with sham treatment.
Inclusion Criteria:
Exclusion Criteria:
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Participants and outcome assessors will be unaware of treatment allocation. The sham procedure will reproduce the active treatment positioning, session duration, and device sound but will not deliver shock wave energy. The urologist administering the intervention will not be masked because the active and sham procedures require different device settings. Randomization codes will be concealed using sealed opaque envelopes prepared by an independent third party not involved in participant recruitment or outcome assessment.
Participants will receive active low-intensity extracorporeal shock wave therapy using the PiezoWave 2 focused extracorporeal shock wave therapy device. Treatment will be administered once weekly for 6 weeks. Before each session, participants will drink 1000 mL of water, and treatment will begin when the bladder reaches approximately 50% of the participant's functional bladder capacity, confirmed by bladder scan. The probe will be placed over the lower abdomen approximately two fingerbreadths above the pubic symphysis and directed toward the bladder dome and bilateral bladder walls. Each session will deliver 1000 impulses to each target area, for a total of 3000 impulses, at an energy density of 0.25 mJ/mm² and a frequency of 3 pulses per second.
Participants will receive a sham procedure once weekly for 6 weeks. The procedure will be similar to the active treatment in participant positioning, bladder preparation, probe placement, session duration, and device sound. A sham probe or zero-energy device setting will be used so that no therapeutic shock wave energy is delivered.
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