Percutaneous Tibial Nerve Stimulation (PTNS) with the Urgent PC system is an effective treatment for Overactive Bladder (OAB) in patients with urinary frequency, urgency, and urge or mixed incontinence. Though not FDA approved for nocturia, many of my patients have reported getting up less often at night. PTNS is uniquely beneficial for those patients who are refractory or intolerant of the medications used to treat OAB. I usually offer PTNS after a patient has failed 2-3 bladder medications, and often can reduce medications during or after treatment.
The success of PTNS is directly related to the proper placement and positioning of the needle electrode. Placing the Needle Electrode approximately 5cm cephalad to the medial malleolus and 2cm posterior to the tibia is critical for the current to effectively reach the tibial nerve. In addition, the angle of the needle may need adjustment based on the thickness of the tissues in the lower leg; this adjustment requires some critical thinking skills. Nurses, in particular Registered Nurses (RNs) and Advanced Practice Nurses (APNs), are well qualified to administer PTNS due to the education they receive in anatomy, physiology, and critical thinking.
Each visit for PTNS allows the RN or APN to visit with the patient and review symptoms, bladder health, and medications. Reinforcing issues related to dietary irritants and fluid intake contributes to a reduction of urinary symptomatology and patient compliance. Patients have reported an appreciation for the time to discuss their specific urinary problems and concerns. The worksheet provided by Cogentix allows us a concise and centralized location for the information we gather during each visit regarding urinary and dietary habits. We use this information to discuss progress with symptoms and to reinforce teaching.
Often a patient is not aware of their subtle improvement. For example, they may still have urinary frequency with 8-10 voids per day. With the documentation we keep at every appointment, we can point out that at the initial visit the patient reported hourly voids. Hourly voiding amounts to about 16 times per day and reducing to 8-10 is a significant improvement. Each visit we reinforce adherence to the dietary bladder irritant list. Often we find that when a patient begins to improve, they revert to bad habits. For example, when the urinary urgency improves, a patient will have that second cup of coffee, and then have worsening bladder symptoms again. I have found that reinforcement of teaching points at each visit eventually leads to compliance in most of my patients.
This blog post reflects the opinions and experience of Peggy Francis, a long-standing user of the Urgent PC Neuromodulation System, and was produced under a paid consulting agreement with Cogentix Medical.
Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for 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 or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at www.cogentixmedical.com. Models are for illustrative purposes only. Urgent is a registered trademark of Cogentix Medical © 2015 Cogentix Medical. All rights reserved.