From the Guidelines
Posterior Tibial Nerve Stimulation (PTNS) is a recommended treatment option for urinary incontinence, particularly for patients with overactive bladder who have not responded to pharmacotherapy or behavioral therapy, as stated in the 2024 AUA/SUFU guideline 1.
Key Points
- PTNS is a minimally invasive treatment that works by indirectly modulating bladder function through peripheral nerve stimulation.
- The procedure involves inserting a thin needle electrode near the posterior tibial nerve at the ankle, which is then connected to a device that delivers low-voltage electrical pulses to the nerve.
- A typical PTNS treatment regimen consists of 12 weekly sessions lasting about 30 minutes each, with maintenance sessions often needed afterward to sustain improvements.
- PTNS is particularly useful for patients with overactive bladder, urge incontinence, or frequency who haven't responded well to medications or behavioral therapies.
- The treatment works by normalizing the neural pathways that control the bladder's muscle contractions and improving coordination between the bladder and urethral sphincter.
- Success rates range from 60-80%, with minimal side effects that may include temporary mild discomfort at the needle site or slight bruising, as supported by the 2024 AUA/SUFU guideline 1.
Treatment Considerations
- PTNS is recommended as a third-line treatment option for carefully selected patients with overactive bladder, as stated in the 2012 AUA/SUFU guideline 1.
- However, the 2024 AUA/SUFU guideline 1 provides a more recent and higher-quality recommendation, suggesting that PTNS can be offered to patients with OAB who have an inadequate response to, or have experienced intolerable side effects from, pharmacotherapy or behavioral therapy.
- The treatment burden and patient preferences should be considered when selecting PTNS as a treatment option, as emphasized in the 2024 AUA/SUFU guideline 1.
From the Research
Posterior Tibial Nerve Stimulation (PTNS) for Urinary Incontinence
- PTNS is a minimally invasive treatment option for patients with urge urinary incontinence, as seen in a study published in 2003 2.
- The treatment involves stimulating the posterior tibial nerve to improve bladder control and reduce symptoms of urinary incontinence.
- A study published in 2020 found that percutaneous posterior tibial nerve electrostimulation (P-PTNS) is effective in treating urge urinary incontinence and faecal incontinence refractory to first-line treatment 3.
Mechanism of Action
- The exact mechanism of action of PTNS is not fully understood, but it is thought to involve the stimulation of the posterior tibial nerve, which sends signals to the brain to help regulate bladder function.
- A systematic review published in 2021 found that PTNS and transcutaneous electrical stimulation (TTNS) of the posterior tibial nerve are effective in reducing urinary incontinence and improving quality of life in patients with overactive bladder syndrome 4.
Efficacy and Safety
- Studies have shown that PTNS is a safe and effective treatment option for patients with urinary incontinence, with significant improvements in symptoms and quality of life 2, 3, 5.
- A randomized clinical trial published in 2018 found that PTNS, pelvic floor muscle training, and lifestyle changes have comparable effects on overactive bladder syndrome 5.
- A narrative review published in 2024 discussed the benefits and safety of PTNS, including its potential as a guideline-recommended therapy for overactive bladder and urge urinary incontinence 6.
Comparison with Other Treatments
- PTNS has been compared to other treatment options, including pharmacological treatments and exercise, and has been found to be an effective alternative 4, 5.
- A study published in 2020 found that P-PTNS is effective in treating urge urinary incontinence and faecal incontinence refractory to conventional treatment, and that treatment response is affected by several factors, including exercise and prolapse 3.