Diagnosis and Treatment Percutaneous Tibial Neuromodulation (PTNM)

AUA/SUFU guidelines for overactive bladder

The American Urological Association and Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Guideline for the diagnosis and treatment of overactive bladder (OAB) in adults is to provide a clinical framework for the diagnosis and treatment of non-neurogenic overactive bladder. The guidance lists Percutaneous Tibial Nerve Stimulation (PTNS), otherwise known as PTNM, as an acceptable treatment in a carefully selected patient population.1

Prevalence of overactive bladder

The number of OAB patients is staggering. OAB is more common than diabetes and the incidence increases every year as the baby boomer population ages.2,3,4,5

  • More than 37 million people in the United States – 1 in 6 adults – suffer from OAB2,3
  • Both men and women
  • All ages
Chart depicting the prevalence of overactive bladder (OAB) in the United States compared to other common health conditions.

Reticence in seeking help for OAB

In spite of this high prevalence, the number of patients presenting OAB symptoms to their clinician is much lower. Many symptomatic patients will not present to their provider for treatment9,10,11 because they see symptoms as a nuisance or as an embarrassment.12,13

Millions of OAB patients are looking for a treatment option that can restore* bladder function and help them improve their quality of life.

Unmet patient needs

Patient compliance with medications, such as anticholinergics (ACs), is low due to variable efficacy and side effects, such as dry mouth and constipation.1 As many as 7 in 10 patients give up taking medication within 6 months.14,15

Percutaneous tibial neuromodulation (PTNM) delivered by the NURO™ system is an effective alternative treatment option for patients reluctant to try medications. Drug-naïve OAB patients treated with NURO PTNM therapy experience a nearly 70% reduction in urgency urinary incontinence episodes (UUIE).16

PTNM is also an alternative for patients whose symptoms have previously failed to respond to medications, but who are not a good candidate for sacral neuromodulation therapy.


With PTNM, restored bladder function is defined as a measurable reduction in urinary frequency and/or urinary incontinence episodes following treatment.


Gormley, A.E., Lightner, D.J., Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment. J Urol. 2015 193(5) 1572-1580.


Stewart WF, et al. Prevalence and burden of overactive bladder in the United States. World J Urol 2003:327-336.


United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-ROM Edition.


National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics Report, 2014. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html. Accessed March 6, 2018.


United States Quick Facts. United States Census Bureau Web site. Available at: https://www.census.gov/quickfacts/table/PST045215/00. Accessed March 6, 2018.


Whitehead WE, Borrud L, Goode PS, et al. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology. 2009;137:512-517.


Alzheimer's Association. Alzheimer's facts and figures. www.alz.org/alzheimers_disease_facts_and_figures.asp. Accessed March 6, 2018.


Coyne, K. S., C. C. Sexton, et al. (2011). National community prevalence of overactive bladder in the United States stratified by sex and age. Urology 77(5): 1081-1087.


Hashim H, Abrams P. Overactive bladder: an update. Curr Opin Urol. 2007;17(4):231-236.


Ricci JA, Baggish JS, Hunt TL, et al. Coping strategies and health care-seeking behavior in a US national sample of adults with symptoms suggestive of overactive bladder. Clin Ther. 2001;23(8):1245-1259.


Erdem N, Chu FM. Management of overactive bladder and urge urinary incontinence in the elderly patient. Am J Med. 2006;119(3 suppl 1):29-36.


Milsom I, Abrams P, Cardozo L, Roberts RG, Thuroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87(9):760-766.


Haab, F. and D. Castro-Diaz (2005). "Persistence with antimuscarinic therapy in patients with overactive bladder." Int J Clin Pract 59(8): 931-937.


Yeaw, J., J. S. Benner, et al. (2009). "Comparing adherence and persistence across 6 chronic medication classes." J Manag Care Pharm 15(9): 728-740.


Kobashi K, Khandwala S, MacDiarmid S, et al. A Prospective Study to Evaluate Efficacy with the NURO Percutaneous Tibial Neuromodulation System in Drug Naïve Patients with overactive bladder syndrome (OAB). Presented at the American Urological Association 2018 Annual Meeting. Journal of Urology. 2018;199(4) Supplement, Page e987.