Altaviva™

Implantable PTNS System For Overactive Bladder (OAB)

The Altaviva™ device is approximately half the length of a stick of chewing gum. Implanted near the ankle, it sends electrical pulses to the tibial nerve to help restore communication between the bladder and the brain. Recharging is needed once or twice a year and takes about 30 minutes to go from zero to 100%, eliminating the need for daily at-home charging.

Overactive bladder is an inconvenient and potentially debilitating condition in which the bladder contracts inappropriately, causing urge urinary incontinence—or leakage. While there are many reasons for an overactive bladder, we know that the neurologic system (the connection between the brain and the bladder) can become disrupted. This disruption causes symptoms ranging from mild leakage to significant loss of continence throughout the day.

We have many treatments for overactive bladder, ranging from medications to implantable neuromodulation devices. Georgia Urology is excited to have recently added the Medtronic Altaviva™ implantable PTNS system to our growing list of options for our patients.

Altaviva can best be described as a bladder pacemaker. It is implanted just above the ankle and is one of the smallest, least invasive implantable options we offer for an overactive bladder.

How It Works

PTNS, or percutaneous tibial nerve stimulation, is not a new therapy. In fact, it has been a frontline therapy for many years. Traditional PTNS involves using an external stimulator on the tibial nerve, which connects to the bladder’s nerve plexus and allows for appropriate pacing of the bladder musculature.

Rather than the 12 weekly clinic sessions a patient once needed, followed by monthly maintenance sessions, the implantable PTNS technology allows for a “one-and-done” minor surgical procedure. The Altaviva device features a rechargeable battery that lasts up to 15 years and requires only a brief recharge at home once or twice a year, depending on usage.

Implantable PTNS vs. Bladder Botox

The implantable PTNS system has unique benefits when compared to bladder Botox. Ultimately, these come down to convenience and patient preference. Bladder Botox lasts 4 to 6 months, while Altaviva can remain functional for up to 15 years. Even when the internal battery eventually reaches the end of its lifespan, replacing the pulse generator is a relatively simple process.

Patients must decide whether they prefer a small surgical procedure above their ankle or repeated injections directly into the bladder. Furthermore, bladder Botox cannot be adjusted once administered, while the Altaviva system can be easily tweaked to match the patient’s changing needs.

Implantable PTNS vs. InterStim™ Neuromodulation

If you’ve browsed other options for overactive bladder treatment, you may have come across Medtronic’s InterStim™ system. InterStim is a pacemaker-sized device implanted under a flap of skin in the lower back with electrodes that stimulate the sacral nerves that control bladder function.

While the mechanism of neuromodulation is very similar, the applications are quite different. InterStim is typically geared toward patients who have more severe cases of OAB, while the Altaviva device is an excellent option for patients with mild to moderate urge urinary incontinence. There can be some overlap for certain patients, and the choice of device is best made in consultation with your Georgia Urology physician.

That said, unlike the InterStim system, there is no “trial phase” where the implantable PTNS device is temporarily tested. However, if external PTNS has been effective in improving a patient’s overactive bladder symptoms in the past, the implantable device will likely offer similar, lasting results

(Note: Georgia Urology also implants another PTNS device known as eCoin®, which works similarly and is implanted in the same area as Altaviva.)

Benefits, Risks, and Considerations of Altaviva

It’s important to note that Altaviva requires a small surgical procedure; therefore, all the risks inherent to this type of procedure apply. Some patients may experience mild pain or minor blood loss at the incision site. Rarely, patients might experience altered sensations in the leg or an infection. These risks can be slightly higher for patients with existing blood vessel issues, such as venous insufficiency, peripheral artery disease, uncontrolled Type 2 diabetes, and other issues that may cause poor wound healing in the extremities.

While rare and very manageable, the PTNS system may not offer enough relief, at which point another therapy can be considered.

Will I be able to stop taking my medications?

For patients who are particularly concerned with taking medications long-term, a device-based solution is likely the way to go if they qualify for implantation. In almost all cases, patients will require fewer daily medications and can frequently avoid them entirely.

While clinical data (such as the TITAN 2 trial*) show that this implantable PTNS device has excellent long-term efficacy, every patient is unique. Whether you will need to continue overactive bladder medications largely depends on how your OAB progresses in the years after implantation.

***Attributed to Dr. Wyatt

*Lee U, Xavier K, Carey J, Pickering A, Harris-Hicks J, Giusto L, Finkelstein K, Kim J, Yaklic J, Gillespie E, Grunow N, Benson K. Implantable Tibial Neuromodulation Therapy Improves Symptoms of Urge Urinary Incontinence from the TITAN 2 Pivotal Study. J Urol. 2026 Jan 26:101097JU0000000000004958. doi: 10.1097/JU.0000000000004958. Epub ahead of print. PMID: 41587348.

This page was reviewed by Bryce Wyatt, MD

Dr. Wyatt graduated magna cum laude from the University of Georgia with a Bachelor of Science in Microbiology. He received his medical doctorate at the Medical College of Georgia. Dr. Wyatt chose to focus on Urology due to the field’s broad scope of both clinical and surgical medicine. While completing his residency in the Department of Urology at the Medical University of South Carolina, he received several recognitions, including the Alexander Kirkland Jr. Excellence in Care Award. His compassion for those in need found Dr. Wyatt providing urological care to veterans, which he cites as a pivotal experience.

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