THERAPY OVERVIEW Percutaneous Tibial Neuromodulation (PTNM)

Office-based Treatment for Overactive Bladder

The Medtronic NURO™ system delivers electrical pulses through a needle to stimulate the afferent fibers of the tibial nerve that runs posterior to the medial malleolus and extends to the sacral nerve plexus. This treatment, called Percutaneous Tibial Neuromodulation (PTNM) or Percutaneous Tibial Neurostimulation (PTNS), can restore* bladder function and quality of life for your OAB patients — without the side effects of medications or potential self-catheterization.

Percutaneous Tibial Neuromodulation (PTNM) Using the NURO System

See how to deliver PTNM with the NURO system.
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PTNM Procedure with the NURO System

PTNM involves placing the needle electrode into the lower, inner aspect of either leg, slightly cephalad to the medial malleolus. A ground pad is snapped to a fitting on the underside of the NURO device, and then adhered to the instep of the foot or the medial aspect of the calcaneus on the same leg. Then the needle holder is connected to the needle.

The NURO device produces an adjustable electrical pulse that travels to the sacral nerve plexus via the tibial nerve. Among other functions, the sacral nerve plexus regulates bladder and pelvic floor function.

PTNM Treatment duration and sequence

The patient is typically treated once per week for 30 minutes for a period of 12 weeks. No decision regarding therapy effectiveness should be made until the patient completes the 12 therapy sessions.

For patients responding to treatment, the time between therapy sessions may be slowly increased after the initial 12 therapy sessions, with the patient closely monitored for the return of symptoms. If symptoms reappear or increase in severity, the patient’s treatment schedule should revert to the last previously effective treatment schedule.

How to administer a PTNM session: step by step

Before you begin, make sure the NURO device is charged. (Device will not deliver a session without sufficient battery power.) Ensure at least one therapy session kit is available and at least one therapy session loaded on the device.

Nuro Therapy Overview Step 1

Firmly insert device cable to needle holder.

Nuro Therapy Overview Step 3

Remove ground pad adhesive and attach to instep of foot.

Nuro Therapy Overview Step 5

Insert needle at 60-degree angle. Gently tap needle to pierce skin. Remove guide tube. Advance approximately 2cm using rotating motion.

Nuro Therapy Overview Step 7

Hold power button to turn on device. Press the power button again to get to the Stimulation Level Adjust Mode. Increase stimulation level and observe for patient response. Then reduce setting by one level and press “Start” to begin session.

Nuro Therapy Overview Step 2

Snap ground pad to back of NURO device.

Nuro Therapy Overview Step 4

Clean skin with alcohol pad. Locate needle insertion site on inner portion of lower leg.

Nuro Therapy Overview Step 6

Connect J hook of needle holder to needle.

Nuro Therapy Overview Step 8

Once 30 minutes have elapsed, Therapy Mode will automatically end. Remove needle. Unsnap and remove ground pad. Turn off device.


Restored bladder function is defined as a measurable reduction in urinary frequency and/or urinary incontinence episodes following treatment.

The most common side effects are temporary and include mild pain or skin inflammation at or near the stimulation site.