About PTNS

PTNS (Percutaneous Tibial Nerve Stimulation) is a non-invasive treatment for symptoms of Overactive Bladder (OAB).

(Non-invasive means it does not involve any surgical cuts to your body, or the insertion of any instruments into your body).

We offer PTNS when a patient's symptoms have not responded fully to other treatments, such as lifestyle changes and regular pelvic floor exercises.

PTNS device.png

We cannot offer you PTNS treatment if:

  • you have a pacemaker or implantable defibrillator
  • you are prone to excessive bleeding
  • you have nerve damage that could impact your percutaneous tibial nerve (ankle) or pelvic floor function
  • are pregnant or planning to become pregnant during the duration of treatment.

Other treatments available

Other treatments available include the following.

  • Medications. 
  • Botox to the bladder wall.
  • SNS (sacral nerve stimulation). This a minor surgical procedure to implant a permanent pulse generator under the skin.
  • Tensi machine. This sends mild electrical pulses through skin-surface electrode pads.

We will discuss these with you, prior to your first PTNS session.

About OAB (overactive bladder)

OAB is a condition with the following urinary symptoms.

  • Needing to pass urine (wee) more frequently during the day and at night.
  • A sudden desperate need to pass urine. This can be accompanied by urgency incontinence (leaking before you can get to the toilet).

OAB affects at least 1 in 10 of the adult population (both men and women).

OAB is more common in the following groups:

  • older people
  • people who have had pelvic surgery (gynaecological or urological)
  • people with neurological (nerve) diseases such as Multiple Sclerosis or Parkinson’s Disease.

However, for many people with OAB, their symptoms have no obvious cause.

About PTNS

The aim of PTNS is to improve your bladder symptoms.

How it works

PTNS is one of a range of treatments known as neurostimulation.

It works by transmitting small electrical impulses through a nerve in your leg (the tibial nerve) to the nerves (sacral nerves) in your lower spine.

The sacral nerves are responsible for regulating bladder and bowel function. Evidence shows that stimulating these nerves can improve bladder control.

Treatment sessions

We will offer you:

  • 12 weekly treatment sessions or
  • 2 treatment sessions per week for 6 weeks.

Important

If you miss appointments, this can affect the outcome of your treatment.

It is important that you keep having PTNS during the first 6 weeks of your treatment. 

You must not miss more than 2 consecutive treatment sessions.

If you have booked a holiday, we advise you to delay the start of your PTNS treatment, until after your holiday.

Speak to us if you have questions about appointment dates.

About treatment sessions

Your sessions will take place in the Kingston Hospital Gynaecology Outpatient department.

Each therapy treatment takes 30 minutes. Patients usually resume everyday activities immediately after treatment.

A CNS (Clinical Nurse Specialist) will carry out your treatment. They will ask you to give verbal consent before treatment starts.

The CNS will do the following:

  • ask you to sit in a chair or on a couch, with your treatment leg raised
  • clean your ankle and the arch of your foot on your treatment leg
  • insert a thin needle electrode above your ankle. Most patients do not find this painful.
  • attach a sticky pad to the arch of your foot
  • connect the the stimulator device (see photo above)
  • turn on the stimulator and adjust the setting.

You will need to keep your leg still, but you can read, do crosswords/sudoku or listen to headphones during treatment.  (Make sure to download your entertainment content before you arrive at the hospital).

Let your CNS know if you are not in a comfortable sitting position.
  • When treatment is finished, the CNS will turn off the machine and remove the needle electrode from your foot.

How treatment feels

Patients respond in different ways, but most feel a buzzing, tingling or throbbing sensation in the ankle or foot. Your toes may spread out and curl.

Let your CNS know if the sensation is too strong. If needed, they can turn down the stimulation so that it is comfortable for you.

Follow-up

When your full course of treatment ends, we will ask you to complete questionnaires about your symptoms and their effect on your daily life.

We will then review your symptoms and discuss further treatment with you (if needed).

More information

British Society of Urogynaecology information on PTNS treatment for overactive bladder.

International Urogynecological Association information on overactive bladder.

Contact information

Kingston Hospital Urogynaecology department
Monday to Friday, 9am to 5pm

Telephone:

020 8934 6407, option 2 or option 4