How Deep Should the Urgent PC Needle Be Placed?
In discussions with other clinicians who are doing Urgent® PC as a PTNS treatment for Overactive Bladder, I’ve heard many different opinions about how needle electrode insertion is done. Some clinicians report inserting the entire needle portion, some put it in “a little,” and some put it “halfway in.” All felt that the depth of the needle may change, based on the thickness or size of a patient’s ankle (e.g., if edema is present or the patient has a “fat” ankle). If you review the Urgent PC Instructions, it says that, “When appropriately inserted, approximately 2 cm (3/4”) of the Needle Electrode will be inserted in the leg.” The needle is 4 cm in length so I guess that is “halfway.”
What is the Ideal Angle for Needle Insertion?
Another recent Urgent PC discussion amongst my colleagues has been about the angle between the needle electrode and the ankle. I have heard several different opinions about this as well. Some have it at 90 degrees, others at 60 degrees. The Urgent PC Instructions notes that the needle placement should be a “position that creates a 60-degree angle between the shaft of the Needle Electrode and the skin.”
My Experience with Needle Insertion
In speaking with Cogentix Medical, I understand that the needle angle and depth cited in the instructions is intended to get the needle close to the tibial nerve without actually touching it. Given the varied size of ankles, it makes sense that needle insertion technique may need to be varied and changed depending on the response the patient receives.
Best practices indicate that 60 degrees is the minimum angle that should be used. In larger patients or patients with edematous ankles, it may be appropriate to increase the angle up to 90 degrees and/or insert the needle deeper so as to get closer to the tibial nerve.
If the patient complains about discomfort or “buzzing” immediately around the needle site, the needle may not be deep enough. In contrast, the needle may be too close to the tibial nerve if the stimulation is extremely uncomfortable.
I have to admit that when I first started doing this treatment, I only placed the needle in “a little.” But I have changed and now insert the needle deeper, sometimes close to that 4 cm point. I feel I get a better response at the level. Since starting Urgent PC, I have changed the angle also. I now put it 90 degrees or “straight up.” I have found that this angle gets me the best response.
This blog post reflects the opinions and experience of Diane Newman, 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 © 2016 Cogentix Medical. All rights reserved.