I am not just an old guy talking about my health, urgency, and incontinence. Are you now, will you be, or do you know someone else (besides me) within the 33 million Americans who suffer from overactive bladder (OAB) symptoms, 50% with actual incontinence? (Statistics from the National Association for Continence – NAFC).
Are you past exercises, diet changes, pads, or other symptom-management paraphernalia? Five years ago, my urologist suggested PTNS, a minimally invasive electrical stimulation of the tibial nerve using an acupuncture needle near the ankle. If that therapy addresses your symptoms, there is a better alternative! TTNS is more comfortable, convenient, and reliable. TTNS, like PTNS, avoids the risks of drug interactions or surgery. Perhaps most importantly, it is much less costly. If TTNS works for you, it is likely better than whatever you may be doing to manage your OAB symptoms, including urgency and incontinence.
In 2022, the NIH reviewed the worldwide evidence, concluded that TTNS results are equivalent to PTNS, and recommended further studies. A 2017 Australian paper reached similar conclusions. Still, none of the five urologists I consulted mentioned TTNS as an alternative.
PTNS and TTNS mean Percutaneous and Transcutaneous Tibial Nerve Stimulation. Both are electrical treatments for overactive bladder (OAB) that are administered monthly after 12 weekly, 30-minute treatments of electrical impulses. Both require a ground pad under the foot arch. PTNS treatments require inserting an acupuncture needle through the skin near the ankle. TTNS uses a pad on the skin instead of a needle. I center the pad on the leg where the PTNS needle is inserted (2 1/4”, i.e., three finger widths above the ankle bone, and ¾”, i.e., one finger width to the rear). Both limit the electric current to a comfortable level for 30 minutes. PTNS devices deliver a maximum current of 9 milliamperes. For TTNS, my TENS device cost me $39.95 delivered. It can deliver 105 milliamperes, but I typically use less current, typically 35 to 55 milliamperes, depending on the maximum that is close to feeling uncomfortable on the day. The FDA and the PTNS device manufacturers (Laborie and Medtronic) only authorize PTNS in a doctor’s office or clinical setting. I self-administer TTNS therapy using my TENS device at home using the ankle stimulation pattern. The pads are reusable, so the total cost per TTNS treatment is approximately $1.00, which is far less than 10% of the cost of either PTNS, pads, drugs, or implant alternatives. My TTNS treatments have been 100% reliable for two years with no side effects.
Is more study really needed? TTNS uses somewhat more electricity and a pad on the skin to replace the needle-nerve contact required for PTNS. Any electrical engineer should understand why TTNS gets the same results and is more reliable than PTNS. TTNS does not depend on needle-nerve contact for success. PTNS does.
Less reliable, more expensive treatments increase direct individual costs and insurance premiums. The present American medical failure does actual harm to patients by not offering the more convenient, less costly, self-administered TTNS treatments. Further, poorly served rural communities and those with limited access to medical clinics and insurance bear the full brunt of the cost and access differences.
American urologists, health insurance companies, medical schools, clinics (including Mayo, the University of Michigan, and Columbia), the government (Medicare, NIH, NAFC, and FDA), and others in the healthcare industry could improve outcomes and reduce costs by utilizing TTNS to address OAB symptoms. The NIH appreciates my “insights on TTNS for treating overactive bladder and on increasing awareness and adoption of the treatment.” After review, the AMA Journal of Ethics “believes my paper should be published” elsewhere. My PCP is supportive.
If you know someone with OAB symptoms, please ask them to consider TTNS therapy.
Louis (“Bernie”) Muench, OAB Patient & Advocate, LBMuench@Gmail.com, 248 563-6453