Prof. Dr. Volkan İZOL | Urologist
Prof. Dr. Volkan İZOL | Urologist

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0322 503 80 70

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0543 333 33 34

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Tibial Nerve Stimulation (PTNS) and Its Use in Urology

Tibial Nerve Stimulation (PTNS) and Its Use in Urology

Tibial nerve stimulation is also known as posterior tibial nerve stimulation (PTNS) or percutaneous tibial nerve stimulation. It is a minimally invasive neuromodulation technique used to treat urinary incontinence and urinary retention.

What Is PTNS and How Does It Work?
 
PTNS regulates bladder function through electrical stimulation of the posterior tibial nerve, which is connected to the S2–S4 sacral nerve roots. This nerve is involved in the control of the bladder and pelvic floor muscles.
 
How it works:
•An electrical stimulus at a specific frequency is sent to the posterior tibial nerve, which runs along the inner side of the ankle.
•These signals are transmitted to the bladder and pelvic muscles via the sacral nerves.
•Overactive bladder (OAB) helps manage conditions such as urinary incontinence and difficulty urinating.
Applications of PTNS
1. Overactive Bladder (OAB)
•Frequent urination (pollakiuria)
•Sudden urge to urinate (urgency)
•Urinary incontinence (urge incontinence)
2. Neurogenic Bladder
•It is used to treat urinary dysfunction associated with neurological disorders such as multiple sclerosis (MS), Parkinson's disease, and spinal cord injuries.
3. Difficulty Urinating and Urinary Retention
•It may be tried in cases of urinary retention resulting from inadequate contraction of the detrusor muscle or bladder outlet obstruction.
4. Interstitial Cystitis / Chronic Pelvic Pain Syndrome
•It may help reduce bladder irritation and pelvic pain.
PTNS App
•Processing time: 30 minutes
•Number of sessions: Once a week for 12 weeks
•Application site: On the inner side of the ankle, approximately 5 cm above the medial malleolus
•Electrode placement:
•The needle electrode (percutaneous PTNS) is placed under the skin.
•A surface electrode (using a transcutaneous PTNS—TENS device) can be used.
The Effectiveness and Benefits of PTNS

✅ It is non-invasive (does not require surgery).
✅ It may be effective in patients who are resistant to medical treatments.
✅ It has few side effects (may cause mild skin irritation or mild muscle twitching).
✅ It can provide long-term symptom control (a 50–80% reduction in urinary incontinence frequency in some patients).

Side Effects and Contraindications

⚠ Caution is advised for those taking blood thinners.
⚠ Not recommended for patients with pacemakers.
⚠ Should not be used during pregnancy.

Is the PTNS Treatment Method Invasive? Are There Any Side Effects?
•PTNS may be a good alternative for patients who are resistant to medication or for individuals who cannot take medication.
•It is less invasive than sacral nerve stimulation or botulinum toxin treatment.
       – We can say it has no side effects.
•The effects may last for the long term, but some patients may require repeat sessions.
Conclusions and Recommendations

✔ In patients with overactive bladder, urinary incontinence, or urinary retention, PTNS is an effective treatment option with a low side-effect profile.
✔ PTNS may be considered in patients who do not respond to medication.
✔ It can provide symptom control in patients with neurogenic bladder and interstitial cystitis.

When used for the appropriate indications, PTNS is an effective method for improving bladder function. However, it may not be suitable for all patients and should be evaluated on a case-by-case basis alongside other treatment options.

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