PTNS Proves Effective For Overactive Bladder When Medications Fail

 Urgent PC Neuromodulation System uses retrograde electrical stimulation of the sacral nerve plexus to treat OAB.
Approximately 16% of the adult population in the United States suffers from an overactive bladder (OAB). These patients experience urinary urgency often accompanied by urge incontinence, urinary frequency and excessive need to urinate at night (nocturia). At Alliance Urology Specialists, we offer a complete range of therapies to provide relief for patients with OAB.

The most common treatment for OAB is a combination of antimuscarinic agents and behavioral therapy; however, approximately 20% of patients don’t respond to this option. For these people, other possible treatments include sacral neuromodulation (InterStim), botulinum toxin injection therapy, and a new minimally invasive therapy called percutaneous tibial nerve stimulation (PTNS). PTNS is delivered by the Urgent PC Neuromodulation System, which uses retrograde electrical stimulation of the sacral nerve plexus to block the neural pathways that transmit unwanted signals to and from the bladder and cause OAB.

“We have found that the majority of our OAB patients benefit from PTNS with some becoming completely continent,” said Scott MacDiarmid, MD, FRCPSC. “We have also had a great deal of success with this therapy in treating patients experiencing nocturia.”

A needle electrode is placed above the medial malleolus next to the tibial nerve and an electrical impulse then travels to the sacral nerve plexus. This blocks unwanted signals to and from the bladder that cause OAB.
Multiple research studies have demonstrated the efficacy and safety of PTNS with objective and subjective success rates ranging between 50% and 80%. Alliance Urology Specialists was one of the few centers in the United States to perform a study comparing PTNS to extended-release Tolterodine 4mg, a common antimuscarinic drug used to treat incontinence. The final results of this trial are
still pending, but initial findings show PTNS to be very effective.

This OAB treatment is performed in our office and usually takes only 30 to 45 minutes. Stimulation is delivered using a needle electrode which is gently placed in the leg above the medial malleolus, next to the tibial nerve. The Urgent PC stimulator delivers an electrical impulse that then travels to the sacral nerve plexus. During this process, the patient sits comfortably and only feels a gentle impulse in their distal foot and toes. Initial treatment sessions are scheduled weekly for 12 weeks. Patients who respond to PTNS usually do so in six to eight weeks. The treatment frequency is decreased after 12 weeks with a goal of maintaining the patient results with monthly, bi-monthly, or quarterly treatments.

Patient Success With PTNS
Beth is a 63-year-old patient with a 10-year history of urge, stress, and frequency incontinence. Like most people who suffer from bladder control problems, Beth was very embarrassed by her condition. The need to always be aware of the closest restroom only added to her anxiety.

Oral medication and medicated patches were somewhat successful in curtailing her incontinence, but these treatments had unwanted side effects of constipation and dry mouth.

With the help of urologist John Wrenn, MD, and Alliance Urology Specialists, Beth found relief with PTNS. She noticed major improvement after just the fourth treatment and, after being incontinent for a decade, is now dry after only 16 PTNS sessions.

“My confidence and feeling of freedom is better than ever,” said Beth. “ I have my life back! I would definitely recommend this procedure to anyone with incontinence.”

PTNS has proven effective with male incontinence problems as well. Donnie is 73 and suffered from OAB with urge and frequency incontinence. He used two pads a day and also experienced nocturia four to seven times a night. Donnie felt the stress of having this condition along with the embarrassment of talking about it with family and physicians.

Initial treatment included five different medications over a six-month period. The drugs helped reduce his incontinence, but nocturia problems continued and he experienced unpleasant side effects.

Dr. MacDiarmid then introduced Donnie to the PTNS treatment, which proved to be extremely successful. He now has no leakage and his nocturia has decreased to no more than two times a night.

“Now I have a sense of control over my incontinence issues,” said Donnie. “I finally feel like myself again.”

To learn more about PTNS and other OAB therapies available at our practice, call 336-274-1114.

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