Non-Invasive Ankle Neuromodulation Suggested For Use Before More Risky and Expensive Surgical Neuromodulation

Jill OsborneThe use of neuromodulation, aka the delivery of a mild electronic pulse to nerves of the bladder, has been used for more than two decades for the treatment of frequency and urgency. There are, however, two consistent methods for performing neuromodulation.

Sacral nerve stimulation, developed by Dr. Richard Schmidt at UCSF in the late 1980’s, requires surgery to implant a lead near the sacrum in the lower back. Known for hundreds of severe side effects submitted to the FDA’s MAUDE database (including fatalities), this more invasive form of neuromodulation can be quite costly, requires careful monitoring and adjustment by a medical professional and may require multiple surgeries over the long term.

Ironically, another doctor at UCSF, Marshall Stoller MD developed a much less invasive form of neuromodulation which he called post-tibial nerve stimulation (PTNS). Using a simple acupuncture needle, it accesses the same nerve where it is closest to the surface of the skin, at the SP6 acupuncture point above the ankle. It requires no surgery for trials, implantation and, importantly, reversal. There are no major side effects and the risk of infection is minimal. In fact, not a single infection has been reported to the US FDA’s Maude Database.

Interstim was sold to large company, Medtronic, who put millions of dollars behind it in education, promotion and marketing. It quickly became popular because it brought more money into clinics. It was also approved by Medicare.

PTNS, on the other hand, lacked corporate sponsorship for several years until Uroplasty created a similar device called Urgent PC. A smaller company, Uroplasty eventually earned Medicare approval, based upon several research studies.

PTNS continues to perform well in research studies and more urologists are offering this less invasive and risky form of neuromodulation.

A new study was released in March which showed that PTNS was also effective for the treatment of refractive overactive bladder (patients who did not respond to oral medication). In a study of 43 consecutive patients, 53% experienced an improvement in their symptoms after just one month of treatment. The researchers concluded that “TPTNS is well tolerated and is effective in one half of the patients studied after they failed anticholinergic treatment. TPTNS could become a second therapeutic option before surgical treatment in the management strategy of OAB.”

By: Jill H. Osborne, MA – President & Founder, Interstitial Cystitis Network

Reference: Ammi M, et al. Transcutaneous posterior tibial nerve stimulation: Evaluation of a therapeutic option in the management of anticholinergic refractory overactive bladder. Int Urogynecol J. 2014 Mar 6.