**1. Introduction**

Overactive bladder (OAB) syndrome is defined as "the presence of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence

of urinary tract infection (UTI) or other obvious pathology" [1]. The prevalence of OAB syndrome increases with age and there is no significant gender difference [2]. Non-neurogenic OAB impairs the patient's quality of life (QoL) and behavioral therapy is recommended as the first line treatment. If behavioral therapy fails, oral medications, including antimuscarinics and β3 agonists, are recommended as the second line therapy [3]. When there is inadequate symptom control or intolerable side effects due to second line management, the American Urological Association (AUA) guidelines recommend either OnabotulinumtoxinA, sacral neuromodulation (SNM), or peripheral tibial nerve stimulation (PTNS) as third line therapy options for OAB symptoms. Third line therapy is undertaken if the patient desires further treatment and is willing to engage in treatment, and/or further treatment is determined by clinicians to be in the patient's best interests. At present, the decision on which third line therapy to perform is based on the clinicians' and patient's preference, and there is not an evidence-based hierarchy available for guidance [3].

There have been several previously published randomized control studies, which compared pairwise treatments with a placebo [4,5]. However, there has not been a direct comparison of the three available treatments, and there has also been a lack of efficiency and safety comparisons between the three treatment options. When multiple treatment modalities are considered, a network meta-analysis could help compare their efficacies. Therefore, we conducted a systemic review to compare the efficacy of OnabotulinumtoxinA, SNM, and PTNS for the treatment of OAB symptoms, using a network meta-analysis.

### **2. Results**
