When Should OAB Patients Begin Seeing Progress With Urgent PC Treatment?
In our world, where the need for immediate gratification is the norm, it is important your patients understand the physiology and progression of improvement with Urgent PC. Patience and perseverance are keys to success. Patients are not better after their first Urgent PC treatment. But every treatment is a step in the right direction.
Urgent PC Overview
Urgent PC is a process whereby mild electrical impulses travel up the tibial nerve to the sacral nerves which are responsible for pelvic floor function and voiding. Stimulating these nerves quiets the overactive bladder, reducing inappropriate bladder contractions and the number of signals sent to the brain, resulting in less urgency, frequency and urge incontinence.
Urgent PC works gently and gradually to improve bladder symptoms through a series of 12, weekly 30-minute treatments. Data suggests that this therapy may also induce changes in the part of the brain that is involved in normal voiding. As a result, patients do not need constant stimulation but are able to sustain symptom relief with a refresher treatment monthly. Most patients will begin to see changes in their voiding patterns around the 4-6th treatment. Decreased urgency and frequency, less urine with leakage and fewer times up at night are all changes that occur at differing points of treatment -- some sooner than others. Predictability is impossible.
Weaning Off Bladder Medications
If your patient is on bladder medications (antimuscarinics/beta 3 agonist) start to wean at the 5th treatment. The patient can take their medication every other day for a week or two, depending on their reported success, or lack thereof, at their next visit. If necessary, have the patient continue to take their drugs for one more week. Your patient does not know that these drugs do not have to be weaned and psychologically it helps them feel comfortable about giving up the medication.
However, VESIcare® (solifenacin succinate) Tablets have a 52-hour half-life so going to every other day might still give them coverage. With that drug you can go to every third day the second week, then off. If the patient is not getting better with PTNS and on medications, continue with PTNS while on the meds. When the patient starts to see improvement, you can push back on the meds. If there is no improvement after 12 Urgent PC treatments, you can stop Urgent PC, go with meds only or continue with both. Choose whichever combination gives the patient the best result.
Urgent PC Response
If the patient is not getting better after the 6-7th treatment, you may wish to review the patient’s chart and your procedure. You should be documenting the ankle, the Urgent PC setting and what the response was. If you are not getting both toe and foot response, rethink needle placement and ankle used. If you are getting poor outcomes, maybe you need to make sure you are getting the maximum response even though in general, you really only need one or the other. Both is ALWAYS the best.
As the provider you need to be satisfied that the patient is getting the maximum stimulation that is still comfortable from the Urgent PC device. It is also crucial that the needle is not inserted too superficially. This can be a bad trap to get into and results in poor outcomes. If the majority of response is stimulation immediately around the needle site, you probably need to go deeper with the needle. In addition, review the use of bladder irritants, compliance with Kegels and urge reduction techniques for the best outcomes.
Education and encouragement are two of your most powerful tools in improving overall outcomes to treatments.
This blog post reflects the opinions and experience of Leslie Wooldridge, 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.