The patient I treated today with PTNS triggered this blog. She received the 5th Urgent® PC treatment today. As I usually do at the start of the visit, I asked the patient: “How are you doing? Any change in symptoms?” Today, she said, “Yes, I am able to hold it better during the day and the last couple of nights, I was able to go 3 hours without getting up to urinate and no leakage.” As you can imagine, she was very pleased. This brings me to this blog on how to know if percutaneous tibial nerve stimulation (PTNS) is improving a patient’s OAB and how to track outcomes.
There are basically two ways:
- Subjective — what the patient tells you and you can observe.
- Objective — what can be measured.
What the patient told me today was subjective. This is something she has noticed since I saw her a week ago. Most patients closely monitor their symptoms and they are fairly reliable, especially if something is working, so each visit I document in the medical record what patients tell me about a treatment outcome.
The second way is to objectively measure improvement. This can be more difficult. I am currently doing research where we are having subjects with urinary incontinence bring in saturated/wet incontinence pads that we weigh to determine the amount of urine leakage. But I have not found this to be very practical in a clinical setting. So in patients who have incontinence, I track improvement by the number or quantity of pads they use on a daily basis.
This is something the patient knows. But many of my PTNS patients just have symptoms of urgency and frequency, so pad weighing or tracking use is not very helpful. I had a male patient who was using an external male (condom) catheter, not because of urine leakage but “just in case.” By the end of the 12 treatments, he had stopped wearing one, so I knew he had improved and he confirmed that he no longer needed his “catheter security blanket.”
The use of a bladder diary can be both subjective and objective as it is a more concrete way to have a patient document symptoms in real time. I usually have the patient complete a 3-day diary at the start of treatment, then at treatment 3, 6, 9 and 12. I have found that this is a good way to “orient” patients to small amounts of improvement that add up over the 12-week period. It also helps me to set goals for the coming weeks.
Most of my patients are compliant about completing a diary. Of course, all is documented in the patient’s record, improvement or not. I would be interested in learning how you track improvement in your PTNS patients.
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 © 2015 Cogentix Medical. All rights reserved.