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Posterior tibial nerve stimulation (PTNS) for overactive bladder (OAB)

Posterior tibial nerve stimulation (PTNS) is regarded as a 3rd line treatment for patients for overactive bladder (OAB) i.e. after medications and bladder retraining with pelvic floor physiotherapy have been unsuccessful in controlling symptoms.

Patient are regarding as having “refractory” symptoms (i.e. symptoms that are poorly responding to the initial treatments for OAB) when they have not responded to or do not tolerate at least 2 of the newer medications available for OAB symptoms.

What is Posterior Tibial Nerve Stimulation (PTNS)?

Posterior tibial nerve stimulation (PTNS) is a form of neuromodulation – i.e. it aims to change the abnormal pattern of stimulation of the nerves that supply the bladder and pelvic floor.

Bladder and pelvic floor muscle function is co-ordinated in the lower part of the spinal cord by the sacral nerves. Electrical stimulation of the posterior tibial nerve (a nerve in the leg which originates at a similar level in the spinal cord as the sacral nerves) sends a message to the sacral nerves that is thought to modify and regulate the nerves that control the bladder.

How does PTNS work?

The PTNS device (called Urgent®PC) produces an adjustable electrical impulse that travels via the tibial nerve in the foot to the sacral nerve plexus, which helps regulate bladder and pelvic floor function.

What does treatment with PTNS involve?

  • Initially 12 treatments are administered at approximately weekly intervals in the consulting rooms.
  • Each treatment session lasts about 30 minutes. Treatments do not require any preparation, fasting or restriction in activities such as driving.
  • In the seated position a fine needle similar to an acupuncture type needle is inserted into the skin just behind the ankle on the inner aspect of the leg.
  • The needle is connected to a device that sends a low-grade electrical signal, which travels up the nerves in the leg to the nerves that control the bladder.
  • A tingling sensation may be felt in the ankle, foot or toes during the treatment.
  • Further “maintenance” treatments are required with PTNS
    • These usually involve a single treatment that may occur once every few months.
    • The ideal long-term treatment frequency is yet to be established and depends on the individual’s response to treatment.

How effective is treatment With PTNS?

PTNS aims to reduce symptoms of urgency, frequency and urge incontinence episodes. Some studies have shown patient response rates of up to 80% with clinically significant improvements in frequency of urination (both day and night), leakage episodes and quality of life.

Advantages of PTNS

  • PTNS is minimally invasive, very well tolerated and has no medication related side effects.
  • It is a simple form of neuromodulation that does not involve a permanently implanted device (such as the InterStim® device).
  • Potential side effects of PTNS are minor such as bruising at the needle insertion site.

Disadvantages of PTNS

  • The treatment costs are not covered by Medicare or Private Health funds and so the individual covers most of the cost of treatment such as the single use disposable needle kit used with each treatment.
  • Need for maintenance therapy at variable intervals.