Managing Patient Expectations
Patients who undergo PTNS treatment with Urgent PC have severe lower urinary tract symptoms that have been refractory to first-line and second-line treatments -- behavioral therapy and drug therapy. Many, if not most, have suffered from these symptoms; urgency, frequency and urinary incontinence, for many years.I find that at the first treatment the patient is so hopeful and eager to see symptoms go away. But my experience with PTNS has taught me that it may be midway through the treatment, the 4th, 5th, or 6th treatment, before a positive change in symptoms is seen. So I feel it is important to work with the patient to manage treatment expectations, as sometimes they may not be realistic.
Understanding the Patient’s Starting Point
I track symptoms each treatment. Before the first treatment, I have the patient do a 3-day Bladder Diary that tracks day and night time voidings, incontinence episodes, triggers (e.g. urgency), and fluid intake. I have them bring the Diary to their next visit. I review the Diary in detail with the patient at the start of the first procedure to obtain "before PTNS symptoms." I ask the patient to identify their most bothersome symptom, as I have learned that, in many cases, my assessment of the worst symptom is not the one the patient wants to go away. I summarize the results of the Diary in the patient’s record. I document my records in an electronic health record so I have developed a “Smart Set” that is a template of a diary and I put in my analysis of that specific patient. I give the patient a copy of my analysis so that they understand where they were when Urgent PC started.
The Importance of Ongoing Tracking
I ask the patient to do additional 3-day Diaries at treatments 3, 6, 9, and 12 weeks, and I document my analysis of each. At these visits, I verbally ask the patient how they think they are doing? Are their symptoms changing? Improving? This is a subjective assessment. I then compare that Diary with previous ones, an objective assessment, and share my findings with the patient and discuss future steps.
With PTNS, I find that the Diary usually validates the patient’s subjective reporting. But there are also times when the patient’s perspective is not validated on the Diary. I then go back to the patient’s treatment expectations and review with the patient, both the Diary findings and the expectations. It may mean that expectations need to change. I have found this approach, of tracking a patient’s progress through the 12 treatments to work in my practice. Try it in your Urgent PC practice.
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.