Percutaneous electrical stimulation (PTNS) is a low-risk, office-based treatment for overactive bladder and associated symptoms of urinary urgency, urinary frequency, and urge incontinence. This non-drug, non-surgical therapy has been recommended by the American Urological Association (AUA) and the Society of Urodynamics,
Female Pelvic Medicine & Urogenital Reconstruction (SUFU) for overactive bladder and has been used in more than a million treatments since 2003. Fifty studies have demonstrated the safety, efficacy, and preference to other third line therapies.

Do you have any of these symptoms?

• Do you use the bathroom more than 8 times during the day or 2 times at night?
  
• When you go somewhere, the first thing you do is find the bathroom in case you have a sudden need to go
  
• Do you often have a sudden need to go with little or no warning?
  
• When you have to go, you can’t ignore it
  
• You have wet yourself because you couldn’t get to the bathroom in time
  
• You limit your activities because of your bladder problems
  

‍How does neuromodulation work?

Bladder function is regulated by a group of nerves at the base of the spine called the sacral nerve plexus. By stimulating these nerves through gentle electrical impulses
(neuromodulation), your bladder activity can be changed. The Urgent PC System provides neuromodulation in a low-risk, in-office procedure, by indirectly stimulating the nerves responsible for bladder function using a nerve in your lower leg.

Urgent PC Neuromodulation System uses percutaneous tibial nerve stimulation (PTNS) to treat the overactive bladder symptoms of urinary urgency, urinary frequency,
and urge incontinence. The Urgent PC Neuromodulation System uses an electrical stimulator that generates specific impulses that are delivered through a lead set to the tibial nerve near the ankle. The stimulator’s impulses travel along the tibial nerve to the nerves in the spine that control pelvic floor function.

What can I expect from treatment with Urgent PC?

A small, slim needle electrode is inserted near your ankle. The needle electrode is then connected to the battery-powered stimulator.

Each of your treatments will last approximately 30 minutes. You will receive an initial series of 12 treatments, typically scheduled a week apart. After the initial 12 treatments, we will discuss your response and determine how often you will need future treatments to maintain your results.

What will I feel with Urgent PC therapy?

Because patients may experience the sensation of the Urgent PC treatment in different ways, it’s difficult to say what the treatment would feel like to you.  However, treatment with Urgent PC is typically well-tolerated by patients. Urgent PC offers many different levels of stimulation, so we will be able to adjust treatment to suit you as well as address any discomfort that you might experience during treatment.

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How soon will I see results?

Because Urgent PC gently modifies the signals to achieve bladder control, the majority of individuals using this type of neuromodulation require at least 6 treatments to experience significant improvement in their symptoms. In one study, patients got better between 2-12 weeks. (3)  For 1 out of 5, it took 8 weeks before they got better. It is important to continue receiving treatments for the recommended 12 treatment series before you can evaluate the full impact of this therapy.

What are the risks associated with Urgent PC?

The risks associated with PTNS treatment are low. Most common side-effects include transient mild pain or skin inflammation at or near the stimulation site.

Urgent PC is contraindicated in these situations:

• Patients with pacemakers or implantable defibrillators
  
• Patients prone to excessive bleeding
  
• Patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function
  
• Patients who are pregnant or planning to become pregnant during the duration of the treatment
  

Resources

1. Percutaneous tibial nerve stimulation (PTNS): A literature-based assessment. MacDiarmid, S.A., et al. (2009). Current Bladder Dysfunction Reports, 4, 29-33.
   
2. Posterior tibial nerve stimulation in patients who have failed anticholinergic therapy: efficacy and time to response. Leong, F., McLennan, M.T., Barr, S.A., & Steele, A.C. (2011). Female Pelvic Med Reconstr Surg 17:2, 74-75.
   
3. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: Results from the Overactive Bladder Innovative Therapy Trial. Peters, K.M. (2009). J Urol, 182, 1055-1061.
   
4. Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder Syndrome: Clinical Effectiveness, Urodynamic and Durability Evaluation. Del Río-Gonzalez, S., Aragon, I.M., Castillo, E., Milla-España, F., Galacho, A., Machuca, J., et al. (2017). Percutaneous Tibial Nerve Stimulation Therapy for Overactive Bladder
   Syndrome: Clinical Effectiveness, Urodynamic and Durability Evaluation. Urology.
   
5. Successful treatment of urodynamic detrusor over-activity in a young patient with Myasthenia gravis using PTNS with follow-up to two years, Antoniou, A., Mendez Rodrigues, J.,  & Comi, N. (2016).   JRSM Open, 7(8), doi:  10.1177/2054270416653684.
   
6. Percutaneous tibial nerve stimulation versus tolterodine for overactive bladder in women: a randomised controlled trial, Preyer, O., Umek, W., Laml, T., Bjelic-Radisic, V., Gabriel, B., Mittlboeck, M., and Hanzal, E. (2015). Eur J Obstet Gynecol Reprod Biol. 191, 51-6.
   
7. Efficacy of percutaneous tibial nerve stimulation (PTNS) for overactive bladder in a community-based urology practice, MacDiarmid, S., Michael, K. (2014). Poster
   presentation, SUFU Winter Meeting, Miami, FL.
   
8. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP Study, Peters, K., Carrico, D., Wooldridge, L.,
   Miller, C., MacDiarmid, S. (2013). J Urol, 189, 2194-2201.
   
9. Cost of neuromodulation therapies for overactive bladder: percutaneous tibial nerve stimulation versus sacral nerve stimulation, Martinson, M., MacDiarmid, S.,
   Black, E. (2013) Technomics Research LLC, Minneapolis, MN. 
   
10. Percutaneous tibial nerve stimulation: a clinically and cost effective addition to the overactive bladder algorithm of care, Staskin, D., Peters, K., MacDiarmid, S., Shore, N., de Groat, W. (2012). Curr Urol Rep, Open Access.