Percutaneous tibial nerve stimulation (PTNS) is an emerging management option in the treatment of refractory urinary incontinence. PTNS is a neuromodulation approach involving retrograde stimulation of the sacral nerve plexus via gauge needle inserted through the skin to activate the posterior tibial nerve. PTNS is thought to be a minimally-invasive approach compared to other neuromodulation techniques. It has shown to be an effective treatment option in comparative studies against medications, botulinumtoxin-A, transcutaneous tibial nerve stimulation and sacral neuromodulation (1,2). 

In Australia, PTNS was approved for the Medicare Benefits Schedule in November 2018. Item numbers exist for an initial induction treatment course over 12 weeks, as well as maintenance options with a tapering course over 3 months and long-term treatment options (3). 
 
The current study sought to investigate the experience of patients who begin PTNS treatments to determine successful completion rates, investigate the reasons patients cease treatment and particular barriers that may exist in a rural setting.

A retrospective analysis was completed from a single provider in Australia. Data was collected from the period November 2018 to March 2023. 
Patient records were examined to determine date of commencement of initial induction treatment and subsequent treatment regime for tapering and maintenance periods. Additional demographic data was examined for patient age, gender and residential location. 
Pre-treatment diagnostic data was examined for urodynamic studies, diagnostic codes and details of previous failed treatments.  
Data collection also considered symptom analysis during treatment. Patient files were examined for completion of a Patient Global Impression of Improvement (PGI-I) assessment at various time points during treatment.

A total of eighty-eight (88) patients were identified as having undergone PTNS treatment in the study period. The majority of patients included in the study were female (89.7% of total participants) with an average age of 72 years (range 18 – 94 years).

Of the participants, over half of patients successfully completed an induction course of PTNS, while seventeen (19%) are currently continuing on maintenance treatment plans. Four subjects have recently commenced PTNS and still involved in induction courses. Only two patients identified were unable to complete the induction treatment course.

PTNS is an appropriate treatment option for the office-based care of patients with urinary incontinence. It provides a non-invasive treatment option for patients although does require a time commitment. The majority of patients successfully complete induction course of PTNS treatment. Various reasons exist for not proceeding with maintenance treatment options, with lack of improvement in symptoms being a major factor. Scope exists for the expansion of services in Australian clinical environments.

1.	Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;189(6):2194-2201. doi:10.1016/j.juro.2012.11.175
2.	Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. . 2010;183(4):1438-43. doi:10.1016/j.juro.2009.12.036, 10.1016/j.juro.2009.12.036
Australian Government, Medicare Benefits Schedule, http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home