Home-Based Posterior Tibial Nerve Stimulation In OAB

Author: Andrea Tyas, Uro-gynaecology Nurse Specialist, Barnsley Hospital

Overactive bladder (OAB) is a common condition that often requires ongoing management when first-line treatments are unsuccessful, placing sustained pressure on outpatient continence services.

The need for regular maintenance percutaneous posterior tibial nerve stimulation (P-PTNS) can contribute to increasing clinic demand, limiting capacity and extending waiting times. This article describes how one UK uro-gynaecology service introduced a homebased maintenance option using transcutaneous tibial nerve stimulation (T-PTNS) for patients who had responded to initial therapy.

Selected patients were supported to manage treatment at home with appropriate clinical follow-up. Early experience from this service suggests that this approach may reduce the need for frequent maintenance appointments, helping to release clinic capacity and improve access for new patients.

Patients also reported improved convenience and flexibility. Incorporating home-based options into care pathways may support more efficient use of specialist resources while maintaining access to clinic-based treatment where required.

Managing Overactive Bladder in The Service

Overactive bladder (OAB) is a common reason for referral to continence and uro-gynaecology services within the National Health Service (NHS) (Irwin et al. 2006; Future Health Research 2025). Patients are typically referred when symptoms such as urgency, frequency or urge urinary incontinence persist despite initial management in primary care (European Association of Urology 2026a; European Association of Urology 2026b).

Within one UK district hospital, female patients with OAB are managed within a dedicated urogynaecology service led by two uro-gynaecology consultants and supported by a team of three specialist nurses. As with most services across the NHS, treatment typically follows a stepwise approach. Initial management focuses on conservative interventions such as bladder training, lifestyle modification and fluid management, alongside pharmacological therapy where appropriate.

For patients whose symptoms remain troublesome despite these measures, the service offers a range of advanced treatment options, including percutaneous posterior tibial nerve stimulation (P-PTNS) and intradetrusor botulinum toxin injections (Botox). P-PTNS is often considered an appropriate next step for patients who prefer a minimally invasive option or wish to avoid the potential risks associated with more invasive procedures.

Transcutaneous Posterior Tibial Nerve Stimulation (T-PTNS)

P-PTNS involves stimulation of the posterior tibial nerve at the ankle, which in turn modulates neural pathways involved in bladder control. Treatment is delivered in the outpatient setting using a fine needle electrode placed near the ankle, typically over a course of weekly sessions for 12 weeks. Patients who experience a good response during this induction phase may then continue with periodic maintenance sessions to sustain symptom improvement (European Association of Urology 2026a; European Association of Urology 2026b).

Illustration of the electrodes and needle position for percutaneous posterior tibial nerve stimulation (P-PTNS) therapy. Adapted from: Khasanah et al. 2022.

This treatment pathway allows the service to provide effective symptom management for patients with refractory OAB while offering access to advanced therapies within a district general hospital setting. However, demand for these treatments is high, with around 40 new patients starting P-PTNS treatment annually at this service and patients currently facing waiting times of up to one year.

The Challenge of Sustaining PTNS Maintenance

While P-PTNS provides an effective treatment option for patients with refractory OAB, the need for ongoing maintenance therapy can create operational challenges for services delivering this treatment.

At this uro-gynaecology service, patients who respond well to the initial 12-week course of P-PTNS are typically scheduled for regular maintenance appointments every three to four weeks in order to sustain symptom control. Over time, this resulted in a steadily growing cohort of patients returning to clinic for repeat treatments.

As the maintenance cohort expanded, a significant proportion of clinic capacity became dedicated to repeat appointments, with clinics often overbooked to accommodate demand.

Each session typically required around 30 minutes of clinician time, in addition to theen use of single-use consumables required for the procedure.

Across the service, approximately 70 patients were attending regular maintenance appointments. When considered over the course of a year, this represented a substantial operational commitment – equivalent to approximately 455 clinical hours (61 clinic days).

In addition to the demands on clinic time, regular hospital visits also placed a burden on patients. Many were required to travel to hospital every few weeks for treatment, which could involve time away from work or other commitments, as well as the practical challenges of transport.

Missed appointments also occasionally occurred, adding further complexity to scheduling and clinic utilisation. At the same time, the volume of maintenance appointments limited the availability of slots for new patients, contributing to extended waiting times for those awaiting initiation of P-PTNS.

The team began to consider whether there might be ways to support patients who required ongoing therapy while reducing the need for frequent in-clinic maintenance appointments.

The challenge was clear: how could the service continue to deliver effective P-PTNS maintenance therapy while creating capacity to meet growing demand and reduce waiting times?

Introducing a Home-Based Maintenance Option

Given the growing number of patients requiring ongoing P-PTNS maintenance and the increasing pressure on clinic capacity, alternative approaches were explored for patients who had responded well to treatment, with the aim of reducing the need for frequent in-clinic appointments.

One potential option was the use of home-based tibial nerve stimulation as a maintenance strategy following successful P-PTNS induction. Transcutaneous posterior tibial nerve stimulation (T-PTNS) delivers electrical stimulation to the same nerve pathway targeted during P-PTNS, but through surface electrodes applied to the skin rather than through a needle electrode.

Tensi+ is a portable device designed specifically to deliver T-PTNS for the management. Unlike general-purpose transcutaneous electrical nerve stimulation (TENS) devices, Tensi+ is programmed with stimulation parameters optimised for tibial nerve stimulation, including specific pulse width and frequency settings intended to stimulate the posterior tibial nerve effectively (Cornu et al. 2025). The device is CE marked and registered with the Medicines and Healthcare products Regulatory Agency (MHRA) by Stimuli Technology for the treatment of OAB (CliniMed Ltd).

From a clinical perspective, the rationale for using T-PTNS as a maintenance therapy is straightforward: both approaches
target the same neural pathway involved in bladder control. Evidence from clinical studies suggests that T-PTNS leads to symptom improvement in patients with OAB, with reported response rates of around 67%, similar to what is seen with P-PTNS. (Cornu et al. 2024; Wang et al. 2020).

In considering this approach, the team recognised that patients who had already responded well to P-PTNS were likely to be suitable candidates for a home-based option targeting the same neural pathway.

This led to exploration of whether a home-based T-PTNS option could be integrated into the existing treatment pathway to support ongoing symptom management.

Tensi+ is a portable device designed specifically to deliver T-PTNS for the management of OAB.

Integrating Tensi+ into the Existing Patient Pathway

Following the initial exploration of a home-based approach, the team undertook a small pilot to assess whether T-PTNS could be used successfully as a maintenance option for patients who had responded well to P-PTNS.

Initial Pilot Experience

The service initially introduced Tensi+ devices to three patients who had previously completed the 12-week P-PTNS induction course and were attending clinic for ongoing maintenance treatment.

Of these first three patients, two were able to maintain symptom control using the device at home. One patient felt that symptoms returned sooner and therefore continued with clinic-based P-PTNS maintenance.

Although limited in scale, this early experience suggested that home-based therapy could offer a practical option for selected patients, and the team began integrating the approach more formally into their existing pathway.

Patient Selection

Tensi+ was offered to patients who had:

In general, the team focused on patients who were likely to be able to manage the device independently and adhere to a home-based treatment schedule.

Introducing the Device in Clinic

Patients were typically introduced to Tensi+ when they attended their first scheduled maintenance appointment following completion of their P-PTNS induction course.

During this visit, the clinical team demonstrated how to position the device, adjust the stimulation intensity and operate the device safely. A standard 30-minute PTNS appointment was typically sufficient to allow for demonstration, patient education and addressing any initial questions. Patients were provided with the device, electrodes and gel, along with written guidance on how to use the therapy at home.

Home Treatment and Follow-Up

Patients were initially advised to use the device once per week with the option to increase frequency to two or three sessions per week if symptoms began to return. Over time, many patients adapted their treatment schedule based on symptom control.

To support ongoing monitoring, patients were asked to complete a simple symptom diary and were scheduled for a follow-up telephone consultation around the time they would otherwise have attended a maintenance clinic appointment. During this call, symptom control and quality of life could be reviewed using a standard questionnaire.

Following completion of their initial P-PTNS treatment, patients were also placed on a patient initiated follow-up (PIFU) pathway, enabling them to contact the service if symptoms worsened or if further support was required.

The introduction of Tensi+ did not replace P-PTNS within the service. Instead, it was used to complement the existing pathway, offering an option for patients to manage maintenance therapy at home while preserving access to clinic-based treatment where needed.

Patient and Service Impact

Following the initial pilot, the use of Tensi+ was gradually expanded within the uro-gynaecology department at this hospital. To date, approximately 30 patients who had completed their 12-week P-PTNS induction course have transitioned to using the device as part of their maintenance therapy.

Patient Experience

Overall, patient response to the home-based approach has been positive. For many individuals, the ability to manage treatment at home has reduced the need for regular hospital visits while still allowing them to maintain symptom control.

Some patients were initially hesitant about moving away from clinic-based treatment, particularly those who valued the reassurance of regular in-person appointments. However, once patients became familiar with the device and understood that clinical support remained available if needed, most were comfortable managing their therapy independently.

Patients have also reported practical benefits associated with home treatment, including reduced travel time, lower transport and parking costs, and greater flexibility in managing therapy around their daily routines.

Service Impact

Alongside improvements in patient convenience, the introduction of Tensi+ has also begun to reduce the demand for routine maintenance appointments within the service.

Prior to introducing the home-based approach, approximately 70 patients were attending the clinic for P-PTNS maintenance every four weeks. This represented an estimated 455 hours of clinical time per year, equivalent to roughly 61 clinic days.

As more patients transition to home-based maintenance therapy, this clinic capacity can be released and redirected towards other areas of care, including improving access for new patients requiring P-PTNS. In the longer term, the team anticipates that as Tensi+ is introduced to the wider cohort of maintenance patients, the clinic sessions currently dedicated to P-PTNS maintenance could be repurposed to support additional treatment capacity, such as expanding nurse led botulinum toxin clinics.

Shifting suitable patients to home-based maintenance also has the potential to reduce the cumulative cost associated with repeated outpatient appointments. The estimated cost of Tensi+ use over a two-year period is approximately £402.20¹, whereas a single in-clinic P-PTNS maintenance session can approach £1000² (plus staff time and consumables).

Importantly, this shift to home-based maintenance can be achieved without removing P-PTNS from the treatment pathway. Patients who require clinic-based therapy can continue to access maintenance treatment, while those who are suitable for home-based management are able to maintain symptom control with greater independence.

1. Tensi+ cost estimation: Tensi+ device (£355), Tensi+ conductive gel (4 x £6.80), Tensi+ replacement electrodes (£20) (CliniMed UK, data on file).
2. P-PTNS maintenance cost estimation: Appointment (£989) + leads (£52.60) (CliniMed UK, data on file)

Key Learnings and Implications for Other Services

The experience at this hospital illustrates how home-based tibial nerve stimulation can be incorporated into routine continence care for patients requiring long-term management of overactive bladder.

Within the service, patients continue to complete the standard 12-week course of percutaneous posterior tibial nerve stimulation (P-PTNS) in clinic. For those who respond well, home-based therapy offers an additional option for maintaining symptom control without the need for regular maintenance appointments in hospital.

In practice, this has allowed some patients to manage their ongoing therapy more independently while maintaining access to specialist support if symptoms change or further treatment is required.

From a service perspective, introducing a home-based maintenance option has the potential to ease pressure on clinic capacity. As more suitable patients transition to home-based therapy, time previously dedicated to routine maintenance appointments can be redirected towards other aspects of care, including assessment of new patients and delivery of additional specialist treatments.

Approaches such as this also reflect a broader shift across the NHS towards supporting patients to manage aspects of their care at home where appropriate, while ensuring that specialist services remain accessible when needed.

For services considering a similar approach, several practical lessons have emerged from the experience:

As demand for continence services continues to grow across the NHS, finding practical ways to support patients while making best use of specialist clinic time will remain an ongoing priority. The experience of this uro-gynaecology service suggests that incorporating home-based tibial nerve stimulation into the PTNS pathway may offer a practical way for services managing OAB to maintain treatment outcomes while improving service sustainability across continence and specialist pathways.

Acknowledgements

The author would like to thank the uro-gynaecology team at Barnsley Hospital for their support in the development of this service initiative and for their contribution to patient care. Their collaboration and clinical input were instrumental in the implementation of the pathway described.

Conflict of Interest

This article was commissioned and funded by CliniMed UK to support its production and publication. The content is based on the independent clinical experience of the author.

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