Percutaneous Tibial Nerve Stimulation for Overactive Bladder (Frequency and Urgency of Urination)

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Approximately 16% of the adult population in the United States suffers from an overactive bladder (OAB). These patients experience urinary urgency often accompanied by urge incontinence, urinary frequency and excessive need to urinate at night (nocturia). At Fairbanks Urology, we offer a complete range of therapies to provide relief for patients with OAB.

The most common treatment for OAB is a combination of antimuscarinic agents and behavioral therapy; however, approximately 20% of patients don’t respond to this option. For these people, other possible treatments include sacral neuromodulation (InterStim), botulinum toxin injection therapy, and a new minimally invasive therapy called percutaneous tibial nerve stimulation (PTNS). PTNS uses retrograde electrical stimulation of the sacral nerve plexus to block the neural pathways that transmit unwanted signals to and from the bladder and cause OAB.

Percutaneous Tibial Nerve Stimuation (PTNS) is a low-risk, non-surgical treatment. PTNS works by indirectly providing electrical stimulation to the nerves responsible for bladder and pelvic floor function. During PTNS treatment, the patient’s foot is comfortably elevated and supported. Also during treatment, a slim needle electrode is placed near the nerve at the ankle known as the tibial nerve. A device is connected to the electrode and sends mild electrical pulses to the tibial nerve. These impulses travel to the sacral nerve plexus, the group of nerves at the base of the spine responsible for bladder function. 

By stimulating these nerves through gentle electrical impulses (called neuromodulation), bladder activity can be changed. Because this change happens gradually, patients receive a series of 12-weekly, 30-minute treatments. After the 12 treatments, when the patient’s response to therapy is assessed, occasional treatments may be needed to sustain symptom improvement.

Who Can Benefit from PTNS Treatment?

This therapeutic treatment is for patients experiencing overactive bladder (OAB) symptoms of urinary urgency, urinary frequency and/or urge incontinence. PTNS has been approved by regulatory agencies outside the United States to treat fecal incontinence, but has not been approved for this usage in the US at this time. PTNS is generally used after behavior modifications, Kegel exercises and failure of medications.

Who Cannot Use Percutaneous Tibial Nerve Stimulation (PTNS)

There are patients who should not be treated with PTNS. These patients are those with pacemakers or implantable defibrillators; patients prone to excessive bleeding; patients with nerve damage that could impact either tibial nerve or pelvic floor function; and patients who are pregnant or planning to become pregnant during the duration of the treatment.

Positive Aspects of Percutaneous Tibial Nerve Stimulation (PTNS)

  • Studies report that 60 – 80% of patients improve with PTNS.
  • PTNS is non-surgical and a  low risk option. It does not require an implant or have lingering side-effects.
  • This therapy is perceived as relatively painless. Patients typically describe the sensation as a “tingling” or a “pulsing” in the foot or ankle.
  • Patients who respond to initial series of treatment can usually sustain symptom improvement with an occasional treatment.

Things to Remember

  • PTNS requires patients to commit to 12-weekly, 30-minute doctors visits.  It may be five to six (5-6) weeks before a patient starts to see improvements. In one study of successful PTNS patients, symptoms improved between 2 – 12 weeks.
  • As with all OAB treatments, results for individual patients will vary.
  • Your health care provider will work with you to minimize any discomfort during treatment. You may experience temporary mild discomfort or redness at or near the stimulation site. However, no major adverse reactions have been reported to date.

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