Question 1

What is PTNS?

Accepted Answer

PTNS is a form of neuromodulation therapy that delivers gentle electrical stimulation to the tibial nerve. The tibial nerve connects to the sacral nerves, which play a key role in bladder function. Modulating these signals can reduce urgency, frequency, and leakage.

Question 2

How is PTNS performed?

Accepted Answer

PTNS is performed by placing a small sensor or electrode over the tibial nerve, just above the ankle.
 
Therapy can be performed as an outpatient procedure.  The stimulation is delivered while you sit comfortably in a chair.  Each session lasts approximately 30 minutes and is typically performed once weekly for 12 weeks.  The stimulation is mild and adjustable to maintain comfort throughout the treatment.
 
A permanent solution that does not require ongoing office therapy is the Altaviva implant.  This is a small implant placed under the skin above the tibial nerve.  The implant is placed during a quick outpatient procedure  that only requires local anesthesia.  Once implanted, the Altaviva will provide ongoing stimulation to the tibial nerve, without the need for returning to the office.

Question 3

Does PTNS hurt?

Accepted Answer

PTNS is generally very well tolerated. Most patients feel a gentle tingling or tapping sensation near the ankle or on the bottom of the foot during treatment. Significant discomfort is uncommon.

Question 4

How soon will I notice improvement?

Accepted Answer

Symptom improvement is often gradual. Many women begin to notice improvement after several sessions, with continued progress over the full treatment course. Because PTNS works by retraining nerve pathways, benefits increase with consistent therapy.

Question 5

Will I need maintenance treatments?

Accepted Answer

Yes.  If you are receiving office treatments, as opposed to the permanent implant, 
maintenance sessions are usually recommended after the initial 12 weekly treatments to sustain improvement. Maintenance schedules vary and are individualized based on symptom response.
 
Patients who receive the Altaviva implant will have ongoing monitoring, usually once every 6-12 months.

Question 6

Is there an option that does not require weekly office visits?

Accepted Answer

Yes. There is now an FDA-approved, small implantable tibial nerve stimulation device called Altaviva by Medtronic.

Altaviva is placed during a brief outpatient procedure in the operating room under local anesthesia. The device is implanted near the tibial nerve and provides consistent neuromodulation without the need for weekly office visits. Unlike traditional PTNS, treatment with Altaviva begins immediately after placement, allowing for continuous therapy without interruption.

This option may be appropriate for patients who want sustained symptom control, have difficulty attending frequent appointments, or prefer a more streamlined long-term treatment approach. Candidacy is determined through careful evaluation and discussion to ensure the option aligns with symptoms, lifestyle, and treatment goals.

Question 7

Who is a good candidate for PTNS or tibial nerve stimulation?

Accepted Answer

PTNS is a good option for women who:

• Have overactive bladder symptoms
 • Experience urgency, frequency, or urge incontinence
 • Have not responded well to medications or cannot tolerate them
 • Prefer a non-surgical or minimally invasive approach

Question 8

Are there risks associated with PTNS?

Accepted Answer

PTNS is very safe. Side effects are uncommon and may include mild ankle irritation or temporary soreness at the stimulation site. Serious complications are rare.

Percutaneous Tibial Nerve Stimulation