Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)
Consultant Urological Surgeon · Medically reviewed:
PTNS is recommended by NICE (IPG362, 2010) as a treatment option for OAB that has not responded to drug therapy, alongside bladder Botox and sacral neuromodulation. It works by modulating the nerve signals to and from the bladder via the sacral plexus, calming the involuntary contractions that drive urgency, frequency and urge incontinence.
Mr Jai Seth co-authored a 2020 study published in Neurourology and Urodynamics on PTNS outcomes in neurogenic and idiopathic OAB, direct clinical experience that informs how he selects and counsels patients for this treatment.
Who is it suitable for?
- Overactive bladder symptoms (urgency, frequency, urge incontinence) that have not improved adequately with lifestyle changes, bladder retraining and a trial of antimuscarinic or beta-3 agonist medication
- Patients who prefer a needle-and-clinic-based treatment over an injection or implant
- Patients who can attend weekly clinic sessions for twelve weeks (the initial course is not flexible, consistency matters for the response)
- No active urinary tract infection at the time of treatment
- No pacemaker or implanted defibrillator (relative caution; discussed at consultation)
- Skin near the ankle intact and free of lesions over the needle site
How does it work?
- A fine needle is placed just above the medial malleolus (the bony prominence on the inside of the ankle), close to the posterior tibial nerve
- An adhesive surface electrode is placed on the foot to complete the circuit
- A small electrical current is delivered for 30 minutes, patients typically feel a mild tingling in the foot or sole, which confirms correct placement
- The stimulation modulates nerve signals travelling up the spinal cord to the sacral plexus, which controls the bladder. Over time this dampens the over-active feedback loop driving OAB symptoms
- Twelve weekly sessions form the initial treatment course; patients who respond move to maintenance sessions every three to four weeks to keep the response going
What to expect
Before the procedure
- An initial consultation confirms that lifestyle measures and oral medication have been tried and that PTNS is the most suitable next step
- A urine sample is checked to rule out infection
- No fasting or special preparation is needed, patients can drive themselves to and from the appointment
- Comfortable, loose clothing that allows easy access to the lower leg makes each session simpler
On the day
- The session takes around 45 minutes total, about 5–10 minutes for setup, 30 minutes of active stimulation, and a few minutes to wind down
- Patients sit or recline with the leg supported. The needle insertion is felt as a small pinprick. Most people read, work on a laptop or talk with the clinician during the session
- There is no anaesthetic and no sedation; patients leave the clinic and resume normal activities immediately
Recovery and aftercare
- There are no activity restrictions after a session, patients return to work, exercise, and driving the same day
- Mild bruising at the needle site is occasional and clears in a day or two
- Patients keep a brief symptom diary across the twelve-week course so the response can be measured against a baseline
- A formal review takes place around the twelfth session to confirm response and decide on maintenance frequency
Outcomes and evidence
- Response rates of around 55–65% are reported in published trials (including the SUmiT randomised controlled trial of the Stoller-style PTNS device), with response defined as a meaningful reduction in urgency episodes, frequency and incontinence at twelve weeks
- Patients who respond at twelve weeks and continue maintenance sessions tend to keep their response over multiple years in long-term follow-up studies
- Mr Seth's 2020 paper in Neurourology and Urodynamics (Tudor et al.) examined PTNS outcomes in patients with both idiopathic and neurogenic OAB, providing direct evidence that informed his clinical practice in this area
- PTNS does not work for everyone, the twelve-week initial course is also a structured trial of whether the treatment is worth maintaining
Risks and complications
- Mild bruising at the needle site, which is the most common side effect
- Brief discomfort or tingling during stimulation, which is the intended effect rather than a complication
- Very rare cases of skin reaction to the surface electrode adhesive
- PTNS is one of the lowest-risk options in the OAB treatment ladder, no surgery, no medication side effects, no implant
- It does require a 12-week commitment to weekly sessions, which is the practical hurdle most patients weigh up
How does it compare to alternatives?
Mr Seth's published research
- Outcomes following percutaneous tibial nerve stimulation (PTNS) treatment for neurogenic and idiopathic overactive bladder. Clinical Autonomic Research (2020).
- Nerve growth factor (NGF): a potential urinary biomarker for overactive bladder syndrome (OAB)?. BJU International (2013).
- C-fibre sensory nerves — not so silent as we think?. BJU International (2013).
See all publications.
Frequently asked questions
Is PTNS painful?
No. The needle insertion is felt as a small pinprick, finer than a venous blood-test needle. The stimulation feels like a mild tingling or pulsing sensation in the foot or sole, which is how the clinician confirms the needle is in the right place. Most patients describe it as unusual rather than uncomfortable, and many work or read during the session.
How long does each session take and how often do I attend?
Each session is around 45 minutes, 30 minutes of active stimulation plus a few minutes for setup either side. The initial course is one session a week for twelve consecutive weeks. Patients who respond then move to a maintenance schedule of one session every three to four weeks to keep the response going.
How will I know if PTNS is working?
Most patients who respond notice a difference by sessions six to eight, with a clearer pattern by week twelve. A bladder diary kept across the course makes the change measurable rather than impressionistic. The twelfth-session review compares the diary against the baseline to decide whether maintenance is worthwhile.
Is PTNS available on the NHS or only privately?
Both. NICE IPG362 supports PTNS for refractory OAB, and many NHS centres provide it for patients meeting the criteria. Private treatment offers shorter waiting times and continuity with the same clinician through the full course. Mr Seth provides PTNS privately at his consulting locations in London.
Can I have PTNS if I have a pacemaker?
PTNS uses a low-energy current delivered locally at the ankle, well away from the chest. Most patients with a pacemaker can safely have PTNS, though the specific device, indication and cardiology advice are reviewed at the consultation before treatment is recommended.
What happens if PTNS does not work for me?
If response at twelve weeks is not adequate, treatment is stepped on rather than abandoned. Bladder Botox and sacral neuromodulation are the two main alternatives at the same level of the NICE pathway, and the consultation after the twelve-week review is where the choice between them is talked through. PTNS not working for you does not mean nothing else will, different mechanisms suit different patients.
Is PTNS the same as TENS?
No. TENS uses surface electrodes on the skin and is used for pain relief. PTNS uses a fine needle placed close to a specific nerve (the posterior tibial nerve) and delivers stimulation deep enough to modulate the nerve signals to the bladder. Surface-only stimulation does not reach the same target reliably, which is why the licensed and NICE-recommended technique is percutaneous.
Can I drive home after a session?
Yes. There is no sedation, no anaesthetic, and no activity restriction. Patients drive, work, exercise and resume their normal day immediately after the session.
Book a consultation with Mr Jai Seth
Private appointments available at Nuffield Health Parkside Hospital, Wimbledon, and other consulting locations across London.
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