What is it?
A treatment for overactive bladder performed by stimulating a nerve near the ankle. What are the symptoms of overactive bladder? Overactive bladder refers to a compelling urge to pass urine that may come on suddenly without warning, and not necessarily with a full bladder. It may be so difficult to postpone that it can result in incontinence or leakage of some urine before you can get to the toilet.
What does it involve?
This treatment is done by placing a fine needle just above the ankle and a surface electrode is stuck on the sole of the foot. These are both connected to a cable used to pass a mild electric current. Patients can usually feel a mild tingling sensation in the ankle, foot or toes. Treatment usually starts with a 30 minute session each week for 12 weeks, (i.e. 12 sessions). If there is no noticeable improvement by treatment 8 we usually recommend not continuing. (If for some reason you have to miss a treatment you can just continue on the next week.) If there is significant improvement after the 12 treatment sessions then usually a top up or maintenance treatment is required every 6 weeks (4-8 weeks) to maintain the benefit.
Will it work and for how long?
The aim of the treatment is to reduce the frequency or urination, the urgency, the volume of incontinence and the daily pad use. In a study of 220 patient, 60 of the 110 patients treated with this procedure, compared to 23 of 110 patients they pretended to treat with a dummy procedure (sham) had noticeable improvements at 13 weeks.
What are the risks and complications?
There are no major safety concerns with this treatment. It is uncommon to experience pain, bleeding or infection where the needle is inserted or unwanted or uncomfortable stimulation during a treatment session. The amount of current can be reduced during a treatment session.
How does it work?
Although the exact mechanism is not fully understood the nerve fibres of the posterior tibial nerve (that runs behind the ankle) originate from the same part of the spinal cord as the nerves to the bladder and pelvic floor.
What are the other options?
Other treatment options for patients who fail to respond to conservative and medical (drug) therapy include Botox injections into the bladder and sacral nerve neuromodulation. The more extensive surgical procedures such as augmentation cystoplasty and urinary diversion are usually the last options.
Version: V2, July 2013