DESCRIPTION
Posterior tibial nerve stimulation (PTNS) is a technique of electrical neuromodulation being proposed for the treatment of voiding dysfunction in individuals who have failed behavioral and/or pharmacologic therapies. Examples of voiding dysfunction include: urinary frequency, urgency, incontinence, and nonobstructive retention. Although the posterior tibial nerve is located near the ankle, it is derived from the lumbar-sacral nerves (L4-S3), which control the bladder detrusor and perineal floor. Altering the function of the posterior tibial nerve with PTNS is being studied as a way to improve voiding function and control.
PTNS can be administered as an invasive or noninvasive procedure. The invasive procedure for PTNS consists of the insertion of a needle above the medial malleolus into the posterior tibial nerve. This is followed by the application of low voltage (10mA, 1-10 Hz frequency) electrical stimulation that produces sensory and motor responses (i.e., a tickling sensation and plantar flexion or fanning of all toes). The noninvasive procedure for PTNS is delivered with surface electrodes. It has been reported that PTNS is administered during 30-minute sessions in an initial series of 10-12 weeks followed by an individualized maintenance schedule. An optimal treatment approach and the durability of PTNS remains uncertain.
POLICY
Posterior tibial nerve stimulation for treatment of urinary dysfunction, including, but not limited to, the following: urinary frequency, urgency, incontinence and retention is considered investigational.
See also: Sacral Nerve Neuromodulation / Stimulation for Pelvic Floor Dysfunction
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Randomized trials with appropriate control groups are needed to determine the durability, short-term and long-term effects of PTNS on voiding dysfunction.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2010). Posterior tibial nerve stimulation for voiding dysfunction (7.01.106). Retrieved December 16,2010 from BlueWeb. (10 articles and/or guidelines reviewed)
Kabay, S. C., Yucel, M., & Kabay, S. (2008). Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: Urodynamic study. Urology, 71 (4), 641-645. (Level 4 Evidence - Independent study)
Stoffel, J. (2010). Contemporary management of the neurogenic bladder for multiple sclerosis patient. Urologic Clinics of North America, 37 (4), 547-557. (Level 5 Evidence - Independent).
U. S. Food & Drug Administration. (2007, August). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071822. Retrieved December 17, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071822.pdf.
Winifred S.Hayes. Medical Technology Directory. (2008, September, last update search August 30, 2010). Electrical percutaneous tibial nerve stimulation for urinary voiding dysfunction. Retrieved December 17, 2010 from www.Hayesinc.com/subscribers. (50 articles and/or guidelines reviewed)
Zhao, J., Bai, J., Zhou, Y.,Oi, G., & Du, L. (2008). Posterior tibial nerve stimulation twice a week in patients with interstitial cystitis. Urology, 71 (6), 1080-1084. (Level 2 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 9/9/2007
MOST RECENT REVIEW DATE: 2/10/2011
ID_BA
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