Andrew Siegel MD 7/29/17
PTNS therapy is a non-drug, non-surgical option to treat OAB symptoms including urinary urgency, frequency and urgency incontinence. PTNS consists of 12 weekly sessions in the office, followed by a maintenance regimen. During each 30-minute session, a thin needle electrode is placed into the ankle region and is connected to an external electrical stimulator. Up to 80% of patients improve with minimal, if any, side-effects.
OAB
Overactive bladder is a common and annoying condition present in both females and males marked by episodes of urinary urgency, frequency and, at times, incontinence. A variety of methods can be used to improve symptoms and quality of life, including the following: behavioral modifications, bladder retraining, pelvic floor muscle training, bladder relaxant medications and Botox injections. Although medications are commonly used for OAB, the problem is that side effects and expense often limit their continued usage.
Neuromodulation
An effective alternative is neuromodulation, the least invasive technique of which is known as PTNS. PTNS uses a thin, acupuncture-style needle placed in the ankle that is attached to a hand-held device that generates electrical stimulation. This is a significantly less invasive means of neuromodulation than is Interstim, which requires implantable wire electrodes to be placed in the spine and continuous electrical stimulation with an implantable battery-powered pulse generator. In both instances, the sacral plexus—responsible for regulating bladder and pelvic floor function—is “modulated” by the electrical stimulation, causing a beneficial effect with improvement of OAB symptoms. With PTNS, the electrical stimulation travels up the tibial nerve to the sacral plexus, whereas with Interstim, the sacral plexus is directly stimulated by electrodes.
Nuts and Bolts of PTNS
PTNS involves once weekly visits to the office for 12 weeks, 30 minutes per session. It can be performed on both female and male patients.
At each session, the patient is seated comfortably with the treatment leg elevated and supported. A fine caliber needle electrode—similar to an acupuncture needle—is inserted into the inner ankle in the vicinity of the tibial nerve. A grounding surface electrode is placed as well. An adjustable electrical pulse is applied to the needle electrode via an external pulse generator. Activation of the tibial nerve is confirmed with a sensory (mild sensation in ankle or sole) and/or a motor (toe flex/fan or foot extension) response. Thereafter, the power of electrical stimulation is adjusted to an appropriate level and the 30-minute session begins. The patient can read, listen to music, nap, meditate, etc.
Clinical Response
Improvement in OAB symptoms often occurs by session 6, sometimes sooner. Patients who respond well to the 12-week protocol may require occasional maintenance treatments. 70-80% of patients will achieve long-term improvement in OAB symptoms. PTNS incurs minimal risks with the most common side effects being mild pain and skin irritation where the needle electrode is placed.
Insurance
PTNS is covered by most insurances, including Medicare. PTNS cannot be used in patients with pacemakers or implantable defibrillators, those prone to excessive bleeding, those with nerve damage or women who are pregnant or planning to get pregnant during the treatment period.
My nurse practitioner and I will be giving a seminar (free of charge) on PTNS on 7PM on Thursday, September 14, 2017 at the Marriott Hotel, 138 New Pehle Avenue, Saddle Brook, NJ. Light refreshments will be served. Space is limited, so if interested, please call 201-487-8866 to reserve a spot.
Wishing you the best of health,
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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery. Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.
Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
Amazon page for Dr. Siegel’s books
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