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Posterior Tibial Nerve Stimulation (PTNS)

Posterior tibial nerve stimulation (PTNS) is a form of neuromodulation used to treat overactive bladder (OAB) and urge incontinence. It can also be used to treat faecal incontinence. Sometimes this is called "Percutaneous Tibial Nerve Stimulation".
Usually, PTNS is used when conservative treatments and medication have been unsuccessful. PTNS is delivered using the Urgent PC® Neuromodulation System made by Uroplasty.

The PTNS Procedure

When you have the PTNS treatment, you will be asked to sit comfortably with your leg elevated. A very fine needle (just like an acupuncture needle) is inserted into the lower leg, slightly above the ankle. This is the area where the tibial nerve runs. A small pad is stuck to the skin on the bottom of the foot on the same leg. This is a bit like the pads that get stuck on your chest if you have an ECG test. These two electrodes (one needle, one skin-pad) are then connected to the pulse generator which delivers an electrical signal that travels along the tibial nerve up to the sacral plexus in the pelvis. One of the functions of the sacral nerve plexus is to control bladder and pelvic floor function.

Once the electrodes are in place, the pulse generator is activated and the strength of the pulse is gently increased until you can feel a tingling sensation going into the foot. There is often an involuntary fanning of the toes. The nerve stimulation is not painful however. The treatment continues for 30 minutes.

How many PTNS treatment sessions are needed?

The treatment is repeated once-a-week for 12 weeks, 30 minutes per session. Many patients begin to see improvements by the 6th treatment. Patients who respond to treatment may require occasional treatments (about once every 3-4 weeks) to sustain improvements.

Are there any side effects or pain with PTNS?

PTNS is a low-risk procedure. The most common side-effects with PTNS treatment are temporary and minor, resulting from the placement of the needle electrode. They include minor bleeding, mild pain and skin inflammation. The treatments are not painful.

Publications and evidence for PTNS

Since the introduction of PTNS, there have been more than 30 published studies in peer reviewed journals. These have similar results, with around 70-80% of patients showing an improvement in their OAB symptoms.

Multicenter RCT Trial of PTNS and Drug Therapy (OrBIT Trial)

The Overactive Bladder Innovative Therapy (OrBIT) trial was a multicenter, randomized controlled trial comparing the effectiveness of PTNS to extended-release tolterodine (one of the commonest OAB medications). A total of 100 adults with OAB were randomized to 12 weeks of PTNS treatment or 4 mg daily extended-release tolterodine. Both groups had reductions in urinary urgency, frequency and incontinence.
80% of those using PTNS reported an improvement in their symptoms, compared to 55% of those on medication. Of those that reponded to PTNS, 73% continued treatment for 1 year and were able to sustain improvement with a top-up treatment every 21 days.

Multicenter RCT Trial Comparing PTNS to Sham (SUmiT Trial)

This study compared PTNS treatment with a sham treatment (ie the same procedure was performed, but without the stimulator working). 55% of “real” PTNS subjects responded to treatment compared to 21% of sham subjects.