Context: Overactive bladder (OAB) is a symptomatic syndrome indicative of lower urinary tract dysfunction. Current treatments for OAB syndrome include behavioral therapy, pharmacotherapy, minimally invasive procedures like sacral nerve stimulation and tibial nerve stimulation, as well as surgical options. Objectives: This systematic review aimed to evaluate the effectiveness of posterior tibial nerve stimulation (PTNS) as a treatment for OAB syndrome and to identify potentially effective stimulation methods. Evidence Acquisition: A systematic search was conducted using PubMed, Scopus, ProQuest, Web of Science, Google Scholar, and The Cochrane Library databases for predefined keywords. Two independent reviewers screened the studies’ titles, abstracts, and full texts. The quality of the studies was assessed using the JBI risk of bias (RoB) checklists. Studies meeting the inclusion criteria were summarized in an extraction table. Meta-analysis was performed using Review Manager Software. Results: Out of 2,282 studies identified, 63 were included in the data extraction table, and 19 of these were included in the meta-analysis to compare the effect of PTNS based on the number of treatment sessions (less than 12 sessions vs. 12 - 24 sessions). Despite heterogeneity among the studies, results showed a significant reduction in voiding frequency post-intervention (95% confidence interval, -4.25 to -1.48, P < 0.0001, Z = 4.06), with a greater reduction in the 12 - 24 sessions group (chi2 = 8.40, df = 1 (P < 0.004); I2 = 88.1%). Additionally, specific electrode placement methods further reduced voiding frequency after PTNS. Conclusions: Posterior tibial nerve stimulation can reduce voiding frequency in patients with OAB and painful bladder syndrome. However, establishing a standard PTNS method remains challenging due to variations among studies and the absence of control groups in many cases. Based on the results, PTNS with a frequency of 20 Hz, pulse duration of 200 µs, and stimulation intensity at the pain threshold appears effective for both transcutaneous and percutaneous techniques over 12 - 24 sessions. The percutaneous method may be more effective than the transcutaneous method.