Percutaneous Nerve Stimulation

What is Percutaneous Tibial Nerve Stimulation (PTNS)?

Percutaneous tibial nerve stimulation is a minimally invasive outpatient procedure to correct overactive bladder (OAB) symptoms such as urinary urgency or frequency and urge incontinence (unintentional leakage of urine).

Concept of PTNS

Your bladder’s function is regulated by a group of nerves at the base of your spine called the sacral nerve plexus. This group of nerves shares the same root as the tibial (shinbone) nerves in your leg. The tibial nerves run along your knee up to nerves in your lower back.

PTNS involves indirect stimulation of the sacral nerve plexus through mild electrical impulses of the tibial nerves. This helps the bladder regulate its function.

Indications for PTNS

You will be recommended to undergo a PTNS procedure if conservative treatments including medication do not help improve symptoms such as follows:

• Painful bladder
• Sudden and strong urge to urinate
• Involuntary loss of urine
• Increased urinary frequency

Candidacy for PTNS

You may be an ideal candidate for PTNS if you do not have a history of nerve damage, bleeding disorders, or a pacemaker/implantable defibrillator. PTNS may not be an option if you are pregnant or planning a pregnancy.

Preparation

No special preparation is required for PTNS. You may need to maintain a voiding diary for a few days prior to your procedure. This will help the surgeon to assess your suitability and response to the treatment.

How is PTNS Performed?

During the percutaneous tibial nerve stimulation procedure:

• You will sit on a chair or couch with your leg elevated.
• The ankle and the arch of your foot are cleaned.
• A small, thin needle is inserted under the skin of your ankle near the tibial nerve.
• An adhesive pad is applied to the arch of your foot and a stimulator box is connected to the needle.

The stimulator delivers gentle electrical impulses along the needle up the tibial nerve and to the sacral nerve plexus, indirectly stimulating it while you remain seated comfortably. The needle is removed after about 30 minutes and you may return home after the procedure.

Risks or Side-Effects of PTNS

Risks or side-effects of PTNS are usually minor and rare but may include:

• Dizziness or fainting in response to the needle insertion
• Generalised swelling or redness at the stimulation site
• Irritation or skin inflammation at or near the stimulation site
• Bruises or bleeding at the needle insertion point
• Slight pain around or near the ankle
• Discomfort, tingling and throbbing pain
• Blood in the urine, headache or stomach ache
• Toe numbness and leg cramps

Aftercare

You will need one session of PTNS every week for 12 weeks. Your doctor will discuss how well your bladder is performing after your twelfth session. You may need to repeat treatment once a month on a long-term basis depending on your condition and response to the treatment.

Benefits

PTNS is a low-risk, non-surgical treatment that can significantly improve urinary continence and boost your quality of life.