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Percutaneous
electrical stimulation (PTNS) is a low-risk, office-based treatment for
overactive bladder and associated symptoms of urinary urgency, urinary
frequency, and urge incontinence. This non-drug, non-surgical therapy has been recommended
by the American Urological Association (AUA) and the Society of Urodynamics,
Female Pelvic Medicine & Urogenital Reconstruction (SUFU) for overactive
bladder and has been used in more than a million treatments since 2003. Fifty
studies have demonstrated the safety, efficacy, and preference to other third
line therapies.
Do you have any of
these symptoms?
- Do you use the
bathroom more than 8 times during the day or 2 times at night? - When you go somewhere,
the first thing you do is find the bathroom in case you have a sudden need to
go - Do you often have a
sudden need to go with little or no warning? - When you have to go,
you can’t ignore it - You have wet yourself
because you couldn’t get to the bathroom in time - You limit your
activities because of your bladder problems
How does
neuromodulation work?
Bladder function is
regulated by a group of nerves at the base of the spine called the sacral nerve
plexus. By stimulating these nerves through gentle electrical impulses
(neuromodulation), your bladder activity can be changed. The Urgent PC System
provides neuromodulation in a low-risk, in-office procedure, by indirectly
stimulating the nerves responsible for bladder function using a nerve in your
lower leg.
Urgent PC
Neuromodulation System uses percutaneous tibial nerve stimulation (PTNS) to
treat the overactive bladder symptoms of urinary urgency, urinary frequency,
and urge incontinence. The Urgent PC Neuromodulation System uses an electrical
stimulator that generates specific impulses that are delivered through a lead
set to the tibial nerve near the ankle.
The stimulator’s impulses travel along the tibial nerve to the nerves in
the spine that control pelvic floor function.
What can I expect from
treatment with Urgent PC?
A small, slim needle
electrode is inserted near your ankle. The needle electrode is then connected
to the battery-powered stimulator. Each of your treatments will last
approximately 30 minutes. You will receive an initial series of 12 treatments,
typically scheduled a week apart. After the initial 12
treatments, we will discuss your response and determine how often you will need
future treatments to maintain your results.
What will I feel with
Urgent PC therapy?
Because patients may experience
the sensation of the Urgent PC treatment in different ways, it’s difficult to
say what the treatment would feel like to you. However, treatment with Urgent PC is typically
well-tolerated by patients. Urgent PC offers many different levels of stimulation,
so we will be able to adjust treatment to suit you as well as address any
discomfort that you might experience during treatment.
How soon will I see
results?
Because Urgent PC
gently modifies the signals to achieve bladder control, the majority of individuals
using this type of neuromodulation require at least 6 treatments to experience
significant improvement in their symptoms. In one study, patients got better
between 2-12 weeks. (3) For 1 out of 5,
it took 8 weeks before they got better. It is important to continue receiving
treatments for the recommended 12 treatment series before you can evaluate the
full impact of this therapy.
What are the risks
associated with Urgent PC?
The risks associated
with PTNS treatment are low. Most common side-effects include transient mild
pain or skin inflammation at or near the stimulation site.
Urgent PC is contraindicated in these situations:
- Patients with
pacemakers or implantable defibrillators - Patients prone to
excessive bleeding - Patients with nerve
damage that could impact either percutaneous tibial nerve or pelvic floor function - Patients who are
pregnant or planning to become pregnant during the duration of the treatment
Resources
- Percutaneous tibial nerve stimulation (PTNS): A literature-based
assessment. MacDiarmid, S.A., et al. (2009). Current Bladder Dysfunction
Reports, 4, 29-33. - Posterior tibial nerve stimulation in patients who have failed
anticholinergic therapy: efficacy and time to response. Leong, F., McLennan,
M.T., Barr, S.A., & Steele, A.C. (2011). Female Pelvic Med Reconstr Surg
17:2, 74-75. - Randomized trial of percutaneous tibial nerve stimulation versus
extended-release tolterodine: Results from the Overactive Bladder Innovative
Therapy Trial. Peters, K.M. (2009). J Urol, 182, 1055-1061. - Percutaneous
Tibial Nerve Stimulation Therapy for Overactive Bladder Syndrome: Clinical
Effectiveness, Urodynamic and Durability Evaluation. Del Río-Gonzalez, S.,
Aragon, I.M., Castillo, E., Milla-España, F., Galacho, A., Machuca, J., et al.
(2017). Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder
Syndrome: Clinical Effectiveness, Urodynamic and Durability Evaluation.
Urology. - Successful
treatment of urodynamic detrusor over-activity in a young patient with
Myasthenia gravis using PTNS with follow-up to two years, Antoniou, A., Mendez
Rodrigues, J., & Comi, N. (2016). JRSM Open, 7(8), doi: 10.1177/2054270416653684. - Percutaneous
tibial nerve stimulation versus tolterodine for overactive bladder in women: a
randomised controlled trial, Preyer, O., Umek, W., Laml, T., Bjelic-Radisic,
V., Gabriel, B., Mittlboeck, M., and Hanzal, E. (2015). Eur J Obstet Gynecol
Reprod Biol. 191, 51-6. - Efficacy
of percutaneous tibial nerve stimulation (PTNS) for overactive bladder in a
community-based urology practice, MacDiarmid, S., Michael, K. (2014). Poster
presentation, SUFU Winter Meeting, Miami, FL. - Percutaneous
tibial nerve stimulation for the long-term treatment of overactive bladder:
3-year results of the STEP Study, Peters, K., Carrico, D., Wooldridge, L.,
Miller, C., MacDiarmid, S. (2013). J Urol, 189, 2194-2201. - Cost
of neuromodulation therapies for overactive bladder: percutaneous tibial nerve
stimulation versus sacral nerve stimulation, Martinson, M., MacDiarmid, S.,
Black, E. (2013) Technomics Research LLC, Minneapolis, MN. - Percutaneous tibial nerve
stimulation: a clinically and cost effective addition to the overactive bladder
algorithm of care, Staskin, D., Peters, K., MacDiarmid, S., Shore, N., de
Groat, W. (2012). Curr Urol Rep, Open Access. - Additional
resources can be found at
