Posted on Apr 13, 2016 7:28:00 AM by Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD

Using PTNS in Overactive Bladder Treatment

Part 6 in the series,OAB Treatment Plans: What Works?

When a patient presents with symptoms of Overactive Bladder, there are a lot of things that come to mind. It is not always as easy as following the AUA/SUFU Guideline for OAB. These guidelines are a great template for finding the right path to take your patients through. However, keep in mind all the little differences patients present with as this may determine successful outcomes. Based on my experience, I have developed a series of blog posts that discuss individualizing treatment plans for the OAB patient.

Urgent PC

Moving forward with Urgent® PC

Refractory overactive bladder can be a challenging syndrome to treat.  Successful treatment seems to take a long time to achieve as there a multiple things to rule out, to manage and to try.  In this example, the patient has decided to try PTNS with Urgent PC as a 3rd line therapy.  Here are some ways I set patients up for success:

  • Treatment always begins with a bladder diary and documentation of previous treatments and outcomes.
  • The patient understands his/her commitment to the therapy and expectations of the treatment.
  • If the patient is on OAB medication, we will keep them on that drug until the 5th At that time we will ask the patient to take the medication every other day.  If the patient feels he/she is improving, we will stop the medication at the 6th treatment.  If not, we will have the patient continue to take the drug every other day. 
  • Behavior management is critical as on-going therapy and reviewed at each session.

Using the Bladder Diary

All patients are required to complete a bladder diary after the 6th treatment.  It is the only objective way the patient can actually see progress as compared to initial complaint, behavioral management, treatment with medication and now PTNS.  It is also helpful with insurance audits.  At the 7th treatment all of this is reviewed with the patient.  It should be noted that some insurances require any bit of success in order to move past that 6th treatment.  According to the bladder record, if the patient has improved, medication is then discontinued. 

Another bladder record is required after the 12th session.  The patient is then scheduled one month after the last treatment for their first maintenance treatment.  If all is well, stretch the treatment to 5 weeks out, then 6, etc. in order to individualize each patient’s treatment schedule.

If OAB Symptoms Return

On occasion, frequency, urgency or nocturia can get a little more frequent after medication has been stopped.  Make sure your patient is following all suggestions for behavioral changes, is doing Kegel exercises and practicing urge reduction techniques.  If this is all happening, it may be necessary to re-introduce the medication.  For severe refractory OAB, it may be necessary to manage combination therapy using behavioral techniques, medication and 3rd line therapy.  Some patients need all three in order to meet their goals. 

Next in the series

Part 7: Defining Treatment Success in Overactive Bladder Treatment
Watch for it next week or subscribe to the blog to ensure you don’t miss any posts in this 7-part series.  

Previous posts

Part 1: Patient History in Overactive Bladder Treatment

Part 2: Physical Exam in Overactive Bladder Treatment

Part 3: Behavioral Management in Overactive Bladder Treatment

Part 4: Medications in Overactive Bladder Treatment

Part 5: Choosing 3rd Line Therapy in Overactive Bladder Treatment

Urgent PC for OAB

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. Urgent is a registered trademark of Cogentix Medical © 2016 Cogentix Medical. All rights reserved. 

Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD
Leslie Saltzstein Wooldridge, GNP-BC, CUNP, BCIA-PMD, is Director of the Adult Bladder Control Center, Mercy Health Partners, Muskegon, Michigan USA. Ms. Wooldridge received a Master of Science degree in nursing administration, critical care nursing and postgraduate certification as a Geriatric Nurse Practitioner from Marquette University, Milwaukee, Wisconsin. In 2015, she was honored with the Women’s Health Foundation Activist Award. She is also the recipient of the 2009 National Association for Continence Rodney J. Appell Continence Champion Award. Ms. Wooldridge has published in multiple refereed journals. She authored the Genitourinary chapter in The Nurse Practitioner in Long Term Care: Guidelines for Clinical Practice (2007). She has lectured throughout the United States on geriatrics, urology and clinical practice.
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