Neuromodulation is a combination of Percutaneous Tibial Nerve Stimulation (PTNS) and InterStim Therapy.
Percutaneous Tibial Nerve Stimulation (PTNS) is a minimally invasive treatment for overactive bladder (OAB) symptoms. While many options are available for the treatment of OAB, including behavioral modification, Pelvic Floor Muscle Rehabilitation (PFMR) and medication, not all patients have success with these. PTNS works by gentle electrical stimulation of the nerves of the sacral nerve plexus to modify the bladder’s activity, sometimes referred to as neuromodulation. The tibial nerve, located in the lower leg, can be accessed with a sensor placed through the skin, the impulses then travel along the tibial nerve and to the sacral nerve plexus.
After your physician determines that you may benefit from PTNS, you return for an initial evaluation with our nurse practitioner who specializes in urinary incontinence. A small needle electrode is inserted adjacent to the tibial nerve in your lower leg and connected to the battery-powered stimulator. These gentle impulses travel up the tibial nerve to the sacral nerve plexus to modify the bladder’s activity. Each treatment last about thirty minutes, and an initial series of twelve treatments are scheduled, each about a week apart. The entire procedure is carried out in the comfort of our office, and following the initial series of treatments you are evaluated by your doctor to assess your response to treatment.
InterStim Therapy is unique in that test stimulation can be performed to assess the effectiveness of the therapy prior to placing the more permanent neurostimulator implant. This test is designed to determine whether your urinary symptoms can be improved through stimulation of the sacral nerves which help to control the bladder.
You will be asked to complete a 4-day bladder diary and bring it to the test appointment. It is important that this diary be as accurate as possible since it will provide the baseline for your bladder symptoms and help to determine the success of the testing.
If the test results in a significant reduction of symptoms, then it will be your option whether or not to proceed to a permanent InterStim implant. The indication, benefits, and risks will be discussed in detail at you appointment.
The test will be done in the doctor’s office and will take approximately 60 minutes including prep time and post-procedure instructions. You will be awake and required to lie on your stomach for 20-30 minutes. The doctor will numb the sacral area (above your tailbone) with a local anesthetic injection. Two temporary test wires (leads) will be placed under the skin, one on the left and one on the right, through a needle which is removed once they have been placed. During the testing you will be asked to identify the location of the stimulation you are feeling. Generally, the stimulation feels like a pulsing, tingling or vibrating sensation felt in the “bicycle seat” area near the vagina or anus.
Here is a helpful link pertaining to Neuromodulation: