Implanted Tibial Nerve Stimulation
Loss of complete bladder control, including the symptoms of urgent urinary incontinence and overactive bladder, is very prevalent. Whether due to age, life events such as pregnancy, or even genetics, this can be a very disruptive and upsetting problem. Urinary incontinence and overactive bladder can affect both men and women. Still, female patients are at greater risk, with estimates of up to 33% of women in the United States suffering from UI.
Many patients do not fully understand the breadth of treatment options for urge incontinence available today. Others, knowing that incontinence is not a life-threatening issue, may feel that living with the problem is preferable to even a minimally invasive procedure. Some continue medications and lifestyle changes despite not achieving the results they hoped for, unaware that practical and elegant solutions are available to them.
Percutaneous Tibial Nerve Stimulation (PTNS) is an effective option that delivers a low-intensity electrical current to the tibial nerve near the ankle via an electrode. Because the tibial nerve is connected to the pudendal nerves, which control the bladder, tibial stimulation can help improve function. PTNS is performed in the office and requires 12 weekly visits, followed by monthly maintenance visits thereafter. New implantable technology has made tibial nerve stimulation more convenient.
eCoin is an FDA-approved, nickel-sized device that is implanted under the skin, near the ankle (adjacent to the tibial nerve), using local anesthesia. eCoin is indicated for refractory urge urinary incontinence. The device automatically and intermittently stimulates the posterior tibial nerve once every two weeks, without requiring patient input.
The implant is permanent, and patients do not need to return to the office for regular follow-up treatments.
When compared to other implanted neuromodulation devices, such as sacral neuromodulation, another option offered by Georgia Urology physicians, the eCoin has some advantages, including that it does not require recharging or a remote control. Also, there are no leads from the device to the tibial nerve, which is one less point of possible failure.
However, tibial nerve stimulation may be somewhat less effective than sacral neuromodulation.
According to an extensive study that served as the basis for the device’s approval by the FDA, approximately 68% of patients responded to treatment with eCoin, meaning they achieved at least a 50% reduction in symptoms of urge urinary incontinence at 48 weeks.
Considering how minimally invasive the procedure is and the fact that the implant is tucked away in the periphery of the body, eCoin is a potentially excellent, low-risk option for qualifying patients.
As with any medication or procedural therapy, some considerations and risks will be thoroughly discussed during consultation with your Georgia Urology physician. Of course, there are the inherent risks of any surgical procedure, no matter how minimally invasive, which may include pain, infection, and blood loss at the incision site in the ankle.
Further, some patients will not achieve the results they are hoping for, while a small subset of patients may experience worsening of symptoms requiring the implant to be removed.
However, when performed by an experienced urologic surgeon and with proper follow-up, most eCoin patients are happy with their decision.
