Percutaneous Posterior Tibial Nerve Stimulation for Overactive Bladder

Percutaneous posterior tibial nerve stimulation (PTNS) for overactive bladders has become a well-established and non-invasive therapy for overactive bladder syndrome (OBS).

Overactive bladder syndrome is a difficult to treat condition where the bladder becomes over sensitive resulting in a constant need to urinate or the feeling that you urgently need to pass urine. 

This debilitating condition has stretched the many medical and surgical specialists to find a cure with often mixed results.

 PTNS is a well practised modality the treatment for overactive bladder syndrome.  Many patients seeking this treatment are often amazed at the results from a relatively simple procedure.

PTNS is performed by placing a needle on the inside of the lower leg, inserted into the skin and close to the Posterior branch of the Tibial nerve.  An electrode patch or second needle is then placed on the foot.  A current is then passed through the needle and electrode, stimulating the posterior branch of the tibial nerve.   

Via a process of retrograde stimulation this procedure achieves neuromodulation in the sacral plexus.  The posterior tibial nerve contains nerves that are mixed with sensory and motor nerves originating from the same spinal segments as the nerves innervating the bladder and pelvic muscles or pelvic floor.  As a result, it is therefore possible to influence these nerves and the central nervous system.  Through a process of sensory bombardment, the nerves of the bladder begin to desensitise becoming less reactive.  The symptoms of OAB are then suppressed.  The exact process of how this mechanism works is still unclear.  Some speculate that symptom relief is achieved via a pain gate mechanism or sensory overload.  

The procedure is carried out by a specialist physiotherapist with 20 years + post graduate experience and over 15 yrs using acupuncture.  The points to locate the tibial nerve are carefully planned and expertly placed. 

It can take up to 12 weekly sessions of 30 minutes for the patient to achieve symptoms relief with a change in symptoms not showing until the 5th session.

 

Evidence:

A RCT of 100 patients reported 80% improved and 55% cured. Another RCT showed that after 1 year 23% of a group were considered cured with 80% better immediately after treatment.

The therapy is recommended by NICE and is therefor considered a cost effective and efficacious modality to tackle this debilitating condition.

More information on evidence can be found here https://www.nice.org.uk/guidance/ipg362/evidence/overview-pdf-495585181

Treatment is exceptionally safe when compared to Botox injection, medication and even surgery.