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ICN Feature Story Comparing PTNS and SNS

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  • ICN Feature Story Comparing PTNS and SNS

    ICN Feature Story - Would you choose a procedure that costs $1800 or $22,614 if they had similar results?

    (By Jill Osborne MA - ICN President) In the1990's, urology researchers determined that if you delivered a mild electronic pulse to the nerves ennervating the bladder that it could reduce episodes of incontinence as well as some frequency or urgency. Developed by Richard Schmidt MD while he worked at UC-San Francisco, sacral nerve stimulation (SNS) involved the implantation of an electrical lead in the lower back and a battery device near the hip. Since 1997, numerous research studies have shown that this method can be successful but is fraught with numerous obstacles, including the cost of surgery, the risk of both mild and serious adverse events (18 fatalities were reported to the FDA in the past two years) and the need for constant medical supervision and/or multiple surgeries to maintain the implanted units.

    At roughly the same time, another researcher at UCSF, Dr. Marshall Stoller, developed a non-invasive approach to nerve stimulation. Called post tibial nerve stimulation (PTNS) procedure, it involved the insertion of an acupuncture needle near the post-tibial nerve, slightly above the ankle bone. This nerve travels through the pelvis and down the leg. Research results were similarly favorable. The cost and risk of this procedure are far less, involving no need for surgery, few adverse events and much lower cost.
    Yet, of the two, the surgical method became quite popular across the country due, in great part, to extensive marketing and financial resources offered by Medtronic. Sadly, the non-invasive PTNS technique and device was juggled between several companies that didn't have significant financial resources. The current version, known as Urgent PC, is being marketed by Uroplasty. Both have received FDA approval and will be covered by Medicare (PTNS coverage begins in 2011),

    So the logical question to ask is "Will the cheaper, safer procedure replace the more extensive, risky method?" In the November issue of the Journal of Urology, Dr. Ragi Doggweiler reviews the pros and cons of both. Research studies show effectiveness with both methods in reducing symptoms. She compares costs with SNS, suggested to cost $22,614 with a cumulative cost of $27,357, while PTNS would cost $1800 for 12 sessions .(1)

    One factor in support of neuromodulation is research released in 2008 that revealed that anticholinergic medications commonly prescribed for bladder symptoms may cause increasing cognitive decline in healthy, older people.(2) She offers "It does make sense to consider PTNS as a replacement for pharmacotherapy in patients on multiple medications to avoid accumulation and interactions. It would be easy to treat patients in assisted living or nursing homes with PTNS and avoid the side effects of anticholinergic medications. However, will it be a substitute for SNS? Time will show, given the economic implications, that PTNS will be considered a first line treatment and cases of treatment failure will undergo testing for SNS."

    I agree. Before committing to a significant, expensive surgery, it makes sense to try the easier, less invasive and more short term therapy first.
    I also must admit to some bias. In 1993, I was referred to UCSF by my urologist where I landed in Dr. Stoller's clinic in tears and desperate for relief. This simple, easy acupuncture needle technique worked for me. I had my first two hours without pain at week 4 and my first day without pain at week 8. In contrast, many of my friends who were Interstim patients had multiple, and often traumatic, SNS procedures.

    Ultimately, the decision to undergo any form of neurostimulation requires careful research and, of course, a physician well experienced in the technique to be used. It's also important to talk with patients who have tried these therapies and learn what the experience was like and what challenges they faced, if any. You can meet others directly in the ICN Support Forum where you'll find four message boards dedicated to neurostimulation. The ICN also offers a Sacral Neuromodulation Checklist that can help guide you through the decision making process and talk with your doctor about the pros and cons.

    (1) Doggweiler R. Will posterior tibial nerve stimulation replace sacral nerve root stimulation as the salvage management of drug resistant urinary urge incontinence? J Urol. 2010 Nov;184(5):1835-6. Epub 2010 Sep 17.
    (2) Han et al. Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. Journal of the American Geriatrics Society, 2008; 56 (12): 2203..
    Would you like to talk with someone about your IC struggles? The ICN now offers personal coaching sessions that include myself, Julie Beyer RD on the diet and Dr. Heather Howard on Sexuality. http://www.icnsales.com/icn-personal-coaching/

    Looking for books, magazines & reports on IC? Please visit the ICN Shop at: http://www.icnsales.com: Your ICN subscription & purchases in our shop support these message boards, chats and special events. BECOME AN ICN ANGEL TODAY!

    Please remember that the information on the ICN is provided with the understanding that ICN, its founder, staff, volunteers, and participants are not engaged in rendering medical or professional medical services. We cannot and do not give medical advice. Only your personal physician can do this for you.







  • #2
    PTNS vs. Surgery

    Jill,
    That is a very interesting article.
    You said you had the PTNS treatments. My question is, does the pain relief eventually become permenent or do you need to continue to have the treatments in order to get the relief?
    Thanks,
    Laurie

    Comment


    • #3
      My urologist suggested that I try these PTNS treatments. I am just waiting for my insurance to approve it. Then, they will get back to me and schedule the appointments. It is worth a try! I will do anything to get better and this seems less invasive. So, my question is...does it hurt? And like the other person asked, do the treatments have to continue or is it permanent? Please tell! This is exciting!

      Check me out on facebook: http://www.facebook.com/glory.ic
      Diagnosed in early 7-2008 w/ IC: glomerations, mucosal cracking, & crystal embedding in the trigone. First cystoscopy & hydrodistention 7-2008
      Fervent prayer to God-I'm seeking divine healing on God's time table-it hasn't happened yet but I trust in Him for deliverance!
      Tried: Hydroxyzine HCL 50mg-I was a zombie! ,Took 300 mg Elmiron daily (over a year later), Instills, Amitryptiline, Cymbalta, Acupuncture, Herbs & marshmallow root tea, Hydrocodone than oxycodone for pain, Tramadol, Soma, Phenazopyridine (pyridium), MSM gel
      Still taking: Gabapentin (3 pills each night-300mg each), Melatonin (natural supplement)
      The latest, trying to cut out wheat & sugar to see if it helps ( I am desperate to find something-other than meds)! I just got off of a oxycodone habit that I originally was using to try & kill pain to function. I believe I had Opioid-induced hyperalgesia! My pain is not much worse giving up the pain meds after taking them for 4.5 years...it's about the same! It was a vicious cycle!
      IC runs in my family-My aunt has the same condition. The women on my maternal side have frequency issues. I have had frequency for many years. The pain started in December 2005 after I was in a car accident. Other : Hip disease (legg perthes as a child-resulting in a damaged femoral head), I had total hip replacement on my right hip in April 2010 at the age of 34. Had a hysterectomy in October 2010 due to pelvic pain & an unusual uterus.

      Comment


      • #4
        Ptns

        Does anyone know of a doctor or clinic in Arkansas, Missouri, or Oklahoma that provides PTNS treatment?

        Comment


        • #5
          My current uro has recommended this to me. He has said he has patients that get relief for up to 6 to 9 months at a time. I didn't ask him if he had any patients who found permanent relief, but I will the next time I am in there. I have an awful time with medication side effects so I am seriously considering this treatment.

          Comment


          • #6
            Ptns

            From what I understand, you have the 12 weekly treatments and then you may need infrequent treatments for maintenance. It hurts a little at the point of the needle insertion, especially if she turns it up, but I don't really feel anything else.

            Comment


            • #7
              Is there a list somewhere of practitioners who will perform PTNS?
              March 2011-Symptoms began
              May 2011-Tentative diagnosis by OB/GYN
              October 2011-Confirmed diagnosis -- IC/PFD

              Current treatments:
              Elmiron- 300 mg (Began 12/11)
              Hydroxyzine- 50-75 mg (Began 7/11)
              Tizabidine- 2mg 3xTID, if needed (Began 12/11)
              IC Diet-Began 5/11
              Pelvic Floor Therapy-Began 12/11

              Current Supplements:
              Cystoprotek
              Magnesium
              Fish Oil
              Biotin

              Comment


              • #8
                Not a good experience

                I had 9 weeks of this treatment (once a week). I refused to get all 12 weeks of it, because it made me flare and I already could not stand 9 weeks of flaring! I was in SO MUCH PAIN as the electrodes that went through the ankle up my bladder, only made my bladder more irritated. I would't ever get the ankle stim again!! Thumbs down! It did not help with pain, but only made me hurt more. Boo. ~Glory Talbott

                Check me out on facebook: http://www.facebook.com/glory.ic
                Diagnosed in early 7-2008 w/ IC: glomerations, mucosal cracking, & crystal embedding in the trigone. First cystoscopy & hydrodistention 7-2008
                Fervent prayer to God-I'm seeking divine healing on God's time table-it hasn't happened yet but I trust in Him for deliverance!
                Tried: Hydroxyzine HCL 50mg-I was a zombie! ,Took 300 mg Elmiron daily (over a year later), Instills, Amitryptiline, Cymbalta, Acupuncture, Herbs & marshmallow root tea, Hydrocodone than oxycodone for pain, Tramadol, Soma, Phenazopyridine (pyridium), MSM gel
                Still taking: Gabapentin (3 pills each night-300mg each), Melatonin (natural supplement)
                The latest, trying to cut out wheat & sugar to see if it helps ( I am desperate to find something-other than meds)! I just got off of a oxycodone habit that I originally was using to try & kill pain to function. I believe I had Opioid-induced hyperalgesia! My pain is not much worse giving up the pain meds after taking them for 4.5 years...it's about the same! It was a vicious cycle!
                IC runs in my family-My aunt has the same condition. The women on my maternal side have frequency issues. I have had frequency for many years. The pain started in December 2005 after I was in a car accident. Other : Hip disease (legg perthes as a child-resulting in a damaged femoral head), I had total hip replacement on my right hip in April 2010 at the age of 34. Had a hysterectomy in October 2010 due to pelvic pain & an unusual uterus.

                Comment


                • #9
                  How can I find doctors in my area who do PTNS? Google is not turning up much for me.
                  My current regimen:
                  Dancing, Laughing, Petting Emily and Louise - my shihtzus

                  Tried and gave up on:
                  Diazepam
                  PFD
                  Warm Baths
                  Millions of supplements
                  Elmiron instillations - did 5 weekly instills and did not help. Gave up.
                  Oxytrol patch - no consistent relief after 3 weeks and very expensive
                  Sanctura XR - tried for 6 weeks with no consistent relief
                  Imipramine - tried for a week, but started to have a "hesitant" void - kind of twitchy.
                  PTNS - doctor's office was disorganized, appts took hours and gave up after 4 treatments
                  Vaginal valium suppositories - not as effective as taking valium orally
                  Cystoprotek - ridiculously overpriced - taking same supplements from CVS
                  Elmiron - 100mg in the morn, 200mg in the late afternoon - no results after 1 year
                  Elavil - 25 mg at night- no consistent relief and 5 extra pounds
                  IV Vitamin C - the only person with an allergic reaction to Vitamin C drips
                  Hormones

                  Comment


                  • #10
                    This article is really intriguing me as my IC had gone into a remission and was doing pretty well for a while back in 04. Then, I was a full-time ER nurse and did a little too much running with the crash cart. I ruptured the posterior tibial tendon and had to have surgery to repair it. I'm just wondering if this is why my IC symptoms returned with such a vengeance.
                    Maybe I'm reading too much into this... but I can't help but wonder.
                    (formerly DonnaRenee1)


                    Diagnoses: IC, fibromyalgia, inflammatory arthritis, connective tissue disease, reynaud's, APS, (the lupus anticoagulant, also known as "sticky blood syndrome")
                    Meds: low molecular weight heparins, synthroid, methadone for pain, tizanidine, cymbalta, pyridium plus, urelle, phenergan for nausea, ambien, lisinopril, norvasc, plaqenuil for arthritis, and over the counter Prelief
                    Treatments: DMSO, occasional hydrodistentions, hot baths, strategically placed heating pads and ice packs, TENS unit, and everything from pity parties to prayer.
                    I have lots of support from my family. My husband and my parents are amazing! I have a wonderful daughter who also has IC, and she has given me 2 precious granddaughters. They are my heart and soul! Thank you God for my family!

                    Comment


                    • #11
                      Re: ICN Feature Story Comparing PTNS and SNS

                      Originally posted by BiblioGrrL View Post
                      Is there a list somewhere of practitioners who will perform PTNS?
                      Yes. www.uroplasty.com

                      Find a provider,

                      Comment

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