University College Hospital. Percutaneous Tibial Nerve Stimulation (PTNS) Gastrointestinal Services Division Physiology Unit

Transcription

1 University College Hospital Percutaneous Tibial Nerve Stimulation (PTNS) Gastrointestinal Services Division Physiology Unit Author: Dr Anton Emmanuel, Consultant Gastroenterologist Images used with the kind permission of Uroplasty Ltd First published: September 2012 Last review date: February 2015 Next review date: February 2017 Leaflet code: UCLH/S&C/GI/PHYSLGY/PTNS/1 University College London Hospitals NHS Foundation Trust Created by Medical Illustration RNTNEH Unique Code: 28796

2 2 11 How to find us The GI Physiology Unit is on the lower ground fl oor of the EGA wing.

3 10 3 Contact details This information leaflet tells you about the treatment which you are going to have. However, if you have read the leafl et and have any queries please contact the GI Physiology Unit. GI Physiology Unit Address: University College Hospital Lower Ground Floor Elizabeth Gareth Anderson (EGA) Wing 235 Euston Road, NW1 2BU Switchboard: or Telephone: Fax: gi.physiology@uclh.nhs.uk If you need a large print, audio or translated copy of the document, please contact us on We will try our best to meet your needs. Contents Introduction 5 How can PTNS help? 5 What are the risks of PTNS? 5 What will happen if I choose not to have PTNS? 6 What alternatives are available? 6 How should I prepare for PTNS? 6 Asking for your consent 6 What happens during PTNS? 7 What should I expect after PTNS? 7 Where can I get more information? 9 How to find us 11

4 4 9 Where can I get more information? The company which developed the Urgent PC device is called Uroplasty. Its fi rst use was for urinary incontinence and so the majority of the information on this site is based on this. Subsequently it was used for faecal incontinence and more recently other bowel dysfunction. The company website is Note: This website is provided for information and education purposes only. No guarantees or warranties are made regarding any of the information contained within this website. References Govaert, B, van Gemert, WG, Baeten, CG (2009) Neuromodulation for functional bowel disorders, Best Pract Res Clin Gastroenterol. 23(4): Jarrett, ME (2005) Neuromodulation for constipation and fecal incontinence, Urol Clin North Am. Feb; 32(1): Govaert, B, Pares, D, Delgado-Aros, S, La Torre, F, van Gemert, W, Baeten, C (2009) Prospective Multicenter Study to investigate Percutaneous Tibial Nerve Stimulation for the Treatment of Faecal Incontinence, Colorectal Dis. Aug 5. Boyle, DJ, Prosser, K, Allison, ME, Williams, NS, Chan, CL (2010) Percutaneous tibial nerve stimulation for the treatment of urge fecal incontinence, Dis Colon Rectum. Apr; 53(4): Mentes et al. (2007) Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury, Preliminary report Tech Coloproctol; 11(2): Epub May 25 Allison, M.E (2009) Percutaneous tibial nerve stimulation: a new treatment for faecal incontinence, Gastrointestinal Nursing. 7 (1): 22 29

5 8 5 Figure 1. Urgent PC Stimulator Introduction This leafl et tells you about Percutaneous Tibial Nerve Stimulation (PTNS). Tibial nerve stimulation or neuromodulation is a relatively new treatment that is used to treat both bladder and bowel problems and in particular, problems with continence or the control of your bladder or bowel. Bowel function is regulated by a group of nerves at the base of the spine called the sacral nerve plexus. Neuromodulation helps in stimulating these nerves through gentle electrical impulses, and can bring about a change in bowel activity. PTNS indirectly stimulates the nerves responsible for bowel function using the tibial nerve in your lower leg. Thus, impulses are sent from your ankle to the sacral nerve plexus via the tibial nerve in your leg. At this hospital PTNS is carried out using a system known as the Urgent PC System for neuromodulation which is a simple device used in the out patient setting. How can PTNS help? You have been referred by your doctor for this treatment because of your bowel symptoms. Based on the available medical literature, we would expect approximately 60 per cent of patients to have some improvement in symptoms. Figure 2. PTNS Procedure What are the risks of PTNS? As with all treatments and procedures there are a few risks with this procedure and these will be discussed with you before you begin treatment. PTNS is not used in patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, those who are pregnant or planning to become pregnant, and with caution in those with abnormal heart rhythms. The risks of PTNS treatment are rare but reported side effects include mild transient pain, throbbing or skin inflammation (at or near to the stimulation site), numbness of the toes and stomach ache. However, PTNS treatment is most often welltolerated by patients.

6 6 7 What will happen if I choose not to have PTNS? You have been referred for this treatment because your doctor thinks that you are an appropriate candidate. If however you choose not to have it, your doctor will talk to you about other possible options to treat your bowel problems depending upon the cause. What alternatives are available? The treatment you have is dependant on your bowel symptoms. Alternative therapies include conservative measures such as addressing diet, exercise, use of medicines, biofeedback, and rectal irrigation or more invasive surgeries. Neuromodulation can also be achieved through a more invasive technique known as sacral nerve stimulation (SNS). SNS has been shown to be effective in patients with faecal incontinence and constipation. PTNS aims to modify these same nerves in a less invasive way. Your doctor will determine the level of intervention you need depending on the cause of your symptoms. How should I prepare for PTNS? No special preparation is required. You will be asked to fill in several questionnaires before, part way through and after your initial treatments in order to assess the progress of your treatment. PTNS is an outpatient procedure; you will not need any help and do not need to be accompanied. Asking for your consent You will not be asked to sign a consent form prior to PTNS. The treatment will be explained to you fully when you come to the department and you will have the chance to ask any questions that you might have. Please do not hesitate to ask questions or voice any worries. If you decide to go ahead, you are confirming that you agree to have the treatment and understand what it involves. What happens during PTNS? You will attend for approximately eight, half hour sessions of stimulation, typically given at weekly intervals. Everyone is different but in general we expect you to undergo several sessions (usually about six) before you see a change in your symptoms. Therefore it is important for you to continue to receive treatment until you and your doctor decide whether it has been successful or not. Your doctor or nurse specialist will choose a healthy area of skin to insert the needle. The area will be cleaned with an alcohol swab and a small, slim needle is gently inserted near to your ankle. The needle electrode is then connected to the battery-powered stimulator and a grounding pad (to complete the circuit) is placed on the bottom of your foot (see figures 1 and 2). After turning on the stimulator, you will be aware of a response in your foot which indicates that the correct nerves are being stimulated. The stimulation will last for 30 minutes and the needle is then removed. After the initial treatment sessions, your response to PTNS will be discussed with you so as to determine if you will need future treatments to maintain your response. If your symptoms are improved further sessions will be undertaken at less frequent intervals. What should I expect after PTNS? You may experience some minor discomfort at the needle entry site but this normally subsides very quickly. If you respond to treatment, the time between treatment sessions will be increased. If symptoms reappear or increase in severity, your treatment schedule will be adjusted so as to be as affective as possible. You will be able to travel home and continue with your normal activities after the test. This leaflet gives you relevant contact numbers and addresses in case you should have any problems.