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Percutaneous Tibial Nerve Stimulation (PTNS) — Office-Based Systems

Percutaneous tibial nerve stimulation (PTNS) is an office-based, non-implanted neuromodulation therapy for urgency urinary incontinence and overactive bladder. A fine needle electrode is inserted near the posterior tibial nerve just above the medial malleolus, and electrical stimulation is delivered for 30 minutes once weekly for 12 weeks followed by maintenance.

Devices​

Urgent PC Neuromodulation System​

  • Originally by Uroplasty / Cogentix Medical, now Laborie
  • Battery-powered external stimulator connected to a fine percutaneous needle electrode
  • First commercially widespread PTNS system (FDA cleared 2005)
  • Still the most commonly used PTNS device globally

NURO System (Medtronic)​

  • Medtronic's office-based PTNS system
  • Similar concept and technique to Urgent PC
  • Single-use kits with needle, electrode, and stimulation cables

How PTNS Works (the Office Session)​

  1. Patient seats with foot elevated
  2. Fine needle electrode inserted 3–5 cm cephalad to the medial malleolus, angled toward the posterior tibial nerve
  3. Surface ground electrode placed on the arch
  4. Stimulation amplitude titrated to produce sensory response (great-toe curl, fanning of toes, or sensation radiating into the sole)
  5. 30-minute session at the elicited threshold
  6. Needle removed; no dressing

Protocol​

  • Induction: 12 weekly sessions
  • Maintenance: every 2–3 weeks (duration variable; often lifelong)
  • Efficacy: ~55–65% improvement in urgency-urinary-incontinence episodes at 12 weeks

Advantages & Limitations​

AdvantagesLimitations
No implant, no surgeryWeekly clinic visits during induction
Outpatient office procedureMaintenance burden — patients must continue indefinitely
Low complication rateCompliance drops significantly at maintenance phase
ReversibleInsurance coverage varies

Relationship to ITNS (Implantable)​

The clinical limitations of PTNS — particularly the maintenance-visit burden — drove development of implantable tibial nerve stimulation (ITNS) devices: eCoin, Revi, and Altaviva all deliver the same neuromodulation principle but via an implanted device that eliminates weekly clinic visits.

See also: eCoin, Revi System, Altaviva, Medtronic InterStim (SNM).