Percutaneous tibial nerve stimulation (PTNS), is the least invasive forms of neuromodulation used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency, urinary frequency and urge incontinence.
Percutaneous tibial nerve stimulation (PTNS), also ref2242ed to as posterior tibial nerve stimulation.
These urinary symptoms may also occur with interstitial cystitis and following a post-radical prostatectomy.
Also used to treat fecal incontinence.
Treatment for overactive bladder and fecal incontinence begins with conservative therapies with a variety drugs.
However almost 80% of patients discontinue use of drugs within the first year and as many as 17% of discontinue treatment being due to adverse side-effects.
Treatment utilizes a fine needle electrode is inserted into the lower, inner aspect of the leg, slightly cephalad to the medial malleolus and sends stimulation through the tibial nerve.
A surface electrode grounding pad is placed over the medial aspect of the calcaneus on the same leg, and the needle electrode is then connected to an external pulse generator.
The external pulse generator delivers an electrical impulse that travels to the sacral plexus via the tibial nerve.
The sacral nerve plexus regulates bladder and pelvic floor function.
The electrical impulse often causes an involuntary toe flex or fan, or an extension of the entire foot, but may only result in a mild sensation in the ankle area or across the sole of the foot.
PTNS is a low-risk procedure with common side-effects that are temporary and minor: including minor bleeding, mild pain and skin irritation.
Has an approximate 80% success rate in treating urge incontinence syndrome, including urgency and frequency, and 78% of patients achieve a long-term improvement in fecal incontinence when treated.
The posterior tibial nerve stimulator efficacy in reducing overactive bladder symptoms in 60 – 80% of patients.
The Overactive Bladder Innovative Therapy (OrBIT) trial was a multicenter, randomized controlled trial comparing the effectiveness of PTNS to extended-release tolterodine.
In this trial 100 adults with urinary frequency were randomized to 12 weeks of PTNS treatment or 4 mg daily extended-release tolterodine: there was a 80% subjective response to PTNS compared to a 55% response to drugs.
After 1 year of therapy. 73% of patients who responded to treatment continued treatment for 1 year and were able to sustain improvement with a treatment every 21 days.
PTNS provides a significant therapeutic effect in the treatment of overactive bladder symptoms.
A needle electrode is inserted into the lower, inner aspect of the leg, slightly cephalad to the medial malleolus to send stimulation through the tibial nerve.
A surface electrode is placed over the medial aspect of the calcaneus on the same leg.
The needle electrode is then connected to an external pulse generator which delivers an adjustable electrical pulse that travels to the sacral plexus via the tibial nerve.
The treatment requires 30 minute once-a-week treatments for 12 weeks.
Occasional maintenance treatments may be helpful to sustain improvement.
Side effects are temporary and minor from the placement of the needle electrode and include minor bleeding, mild pain and skin inflammation.
Studies suggest 70-80% success rate in treating urge incontinence syndrome, including urgency and frequency, with similar response rates for fecal incontinence.
Associated with no major safety concerns.
In the SUmit trial the efficacy of PTNS for fecal incontinence has been demonstrated.
Percutaneous tibial nerve stimulation (PTNS), also ref2242ed to as posterior tibial nerve stimulation, is the least invasive forms of neuromodulation used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency, urinary frequency and urge incontinence.
Urinary urgency, urinary frequency and urge incontinence may also occur with interstitial cystitis and following a post-radical prostatectomy.
PTNS is also used to treat fecal incontinence.
Overactive bladder and fecal Incontinence begins with conservative therapies including pharmacology.
OAB drugs available that generally produce similar overall efficacy and side-effects.
Nearly 80% of patients discontinue use of drugs within the first year.
As many as 17% of patients discontinue over active bladder drugs due to adverse side-effects.
A patient sits comfortably with the treatment leg elevated.
A fine needle electrode is inserted into the lower, inner aspect of an elevated leg, slightly cephalad to the medial malleolus to send stimulation through the tibial nerve,.
The needle electrode must be near, but not on, the tibial nerve.
The needle electrode is then connected to an external pulse generator which delivers an adjustable electrical pulse that travels to the sacral plexus via the tibial nerve.
The sacral nerve plexus regulates bladder and pelvic floor function.
With placement of the needle electrode, there is often an involuntary toe flex or fan, or an extension of the entire foot., but , for some patients stimulation may only result in a mild sensation in the ankle area or across the sole of the foot.
The treatment protocol requires once-a-week treatments for 12 weeks, 30 minutes per session.
Many see improvement by the 6th treatment, and in patients who respond to treatment may require occasional treatment every 3 weeks to sustain improvements.
A low-risk procedure with occasional minor bleeding, mild pain and skin inflammation.
The process has an approximate 70-80% success rate in treating urge incontinence syndrome, including urgency and frequency.
The Urgent PC Neuromodulation System is the only PTNS device commercially available today.
PTNS efficacy in reducing OAB symptoms in 60 – 80% of patients.
The Overactive Bladder Innovative Therapy (OrBIT) trial was a multicenter, randomized controlled trial comparing the effectiveness of PTNS to extended-release tolterodine: it showed there was a 80% subjective response to PTNS compared to a 55% response to drugs.
The study demonstrated sustained therapeutic effects of PTNS in subjects with OAB through 1 year of therapy. 73% of patients who responded to treatment continued treatment for 1 year and were able to sustain improvement with a treatment every 21 days.
Efficacy of PTNS achieved after 12 weeks of therapy for improvement in frequency, nocturia, urgency, voided volume, and urge incontinence episodes from baseline and is durable through 12 months of continued therapy at varied intervals.
The Study of Urgent PC vs. Sham Effectiveness in Treatment of Overactive Bladder Symptoms, a multicenter, double-blind, randomized, controlled trial comparing the efficacy of PTNS to sham through 12 weeks of therapy: demonstrated statistical superiority with 55% of PTNS subjects responding to treatment compared to 21% of sham subjects.
Efficacy of PTNS for fecal incontinence has been demonstrated by prospective, multicenter studies.