Positive Foot Responses to PTNS
Sometimes it can be frustrating, especially when you are in a hurry, to try to get a motor or sensory response from PTNS stimulation.
Over the years I have found that patience really pays off. I believe it is one of the reasons our clinic has positive outcomes in regards to bladder symptoms of urgency, frequency and incontinence. Technique is always key to getting a good response.
Needle Insertion - Not A Perfect Science
Be sure that you are inserting needles at a 60° angle, 3 finger breadths above the middle of the malleolus and halfway back to the Achilles. Granted we all have different size fingers, some fuller than others. So, think about the distance about 3 cm or 1.5 - 2 inches up from the middle of the malleolus. It’s not a perfect science because you also want to take into consideration the size of the patient’s ankle and how much swelling there may be. You will get the hang of it. Remember – patience!
Per the Instructions for Use, either a foot or a sensory response is sufficient to confirm ideal needle placement. However, I like to try for both.
The ideal foot reaction is a fanning or slight movement of the toes (or toe) along with a buzzing feeling (like your foot is falling asleep) in the bottom of the foot or heel. You have to be careful that the patient is not moving a toe in response to you just advancing the needle. Ask them to try to move one of their five toes independently. See how it goes. That should give you an idea of what is response to stimulation versus plain old motor response that anyone can make happen.
NOTE: if the patient is feeling the “buzzing” around the needle site, most likely you are not in far enough. Continue to advance the needle until the proper response is noted. Yes, you can get needle buzzing along with toe(s) flexion and foot/heel response for a positive response. You can also get either toe movement OR heel/foot response. Or patients can just have a sensory response. Any is acceptable. I always recommend to those I teach to have a treatment themselves so you can better explain to your patient’s proper response along with feelings and reactions.
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.