Opinion
Video
Current Expert Opinions on Sacral Neuromodulation and Tibial Nerve Stimulation Therapies for OAB
In this insightful episode, Dr. Kennelly engages with Dr. Eilber and Dr. Benson in a comprehensive discussion of sacral neuromodulation and transcutaneous and posterior tibial nerve stimulation therapies used in the treatment of OAB, including their mechanisms, patient reception of FDA-approved devices, overall evolution and current practices implementation in clinical settings.
Transcript:
Dr Kennelly: For the next little bit, let's talk specifically about each of the therapies. Dr. Eilber, for posterior tibial nerve stimulation therapy, how have you found that in your practice? Is it a viable procedure offered to your patients? Is it utilized? Are you noticing any difficulties with it?
Dr. Eilber: I utilize it quite a bit and again I think part of it may be my demographic where there's a lot of maybe alternative medicine. A lot of people get acupuncture so they can relate to it very well. You know they're already familiar with if you have acupuncture you have repeated visits, you know They kind of conceptually understand like trying to you know, regulate or modulate a nerve and You know the good thing about doing the tibial nervous stimulation is they really should be responding after the first six weeks So you can tell patients if you really have zero response after six weeks I truly do not believe it is worth going to you know, eight or twelve to see any more So you can just tell the patients okay, we can try it for six weeks. If they don't see a response, you can move on to a different therapy. If they don't have a response to tibial nerve stimulation, I don't believe they won't necessarily respond to sacral nerve modulation. I can tell them, you know, you can also explain to them, we're getting a branch of that nerve. So if they're really still interested in neuro modulation and they have not had a response to tibial nerve stimulation, that's when we can talk about, you know, doing a peripheral nerve evaluation or PNE in the office to see if sacral neuromodulation would work better for them.
Dr Kennelly: I think, you know, the therapy is a great therapy. Well, one thing I found in our practice is that, you know, they're coming in once a week. So if they're doing it for 12 weeks, that's 12 treatments, which is 12 times to try to place that needle close to the tibial nerve, which is, in our practice, sometimes dependent on different providers who are doing it. with different skill levels. So that's something that hasn't been addressed. Have you found that in your practice?
Dr. Eilber: There are, I think if there is even a little bit of edema, I think finding the nerve every week gets difficult, but I did buy some henna, you know, like henna tattoos. So the people who are hard sticks, we were apply the henna to the same spot every week and we've actually gotten rid of that problem.
Dr. Kennelly: That's great. That's a good suggestion. Thank you. Dr. Benson, do you have any sort of experience with say eCoin therapy, which are the FDA approved devices? And if you do, can you elaborate on kind of your experience?
Dr. Benson: Sure. So I've worked with most of the newer implants as part of clinical studies. I've worked with a lot of other people and I've worked with a lot of other people and I've worked with a lot of other people and I've worked with a lot of other people and I've worked with a lot of other people and I've worked with a lot of other people And I would say that they each have nuanced benefits and drawbacks, but in general across the class, they're excellent. I think that they're providing a minimally invasive, new way to modulate this nerve, which is just what we're looking for. I think that the real question in it is what we would say above the fascia or below the fascia, do we put? in an electrode array? Do we put in a device? There's some nuanced little differences in issues that may or may not be a bigger issue in the future. I don't think that's yet been determined.
But whether you look at any of them that have had clinical studies across the board, they're successful. I think that whether they'll be as successful as Sacral, I don't know yet. And maybe that's a trade-off. Maybe you say it's slightly less effective for less OR time, less invasiveness. You know, and again, whether that's true or not, I don't fully know that. But clinically so far, they've been effective and they've been really well received by patients. I think when patients understand that they have a way of getting better, the novelty of perhaps working in the ankle is something that they find interesting. I think for many of us doing it, we're a little bit worried initially to do it, but it can certainly be done safely, effectively, and with good outcomes.
Dr. Kennelly: Yeah, and I think one of the things you think about sacral neuromodulation, it's been over 25 years. So there's obviously a learning curve, a developmental process that goes on. And I think early on, we've improved quite a bit. Now, I think it's pretty standard. that surgeons realize, interoperably, trying to get at least four out of four leads, less than two milliamps to get both motor and sort of a bellows response and a plantar toe flexion response prior to leaving the OR. That has at least improved the efficacy and long-term durability of sacral neuromodulation. Karen, what has been your experience regarding sacral neuromodulation?
Dr Eilber: I was literally a resident when sacral neuromodulation came out. It's interesting as it has evolved over time, I think that certainly it has become a better device. You know, I mean, Mike, we're old enough that the old leads we had to open up all the way the fashion and tied in place. You know, and those, I mean, you already knew they moved before even left the OR, right? And we were happy. to get, you know, response on one part lead. Now, you know, we're spoiled. We want to get response on all four points. I think that having the times on there make it easier. I think having the curve lead, for sure, there's been better response. I definitely do more sacral neuromodulation now because the office test also improved. You know, back in the day, the old office wire, again, I think before the patient ever left the office. it already fell out. So I think that with the new P &E's that we have, I think you get a much better evaluation. It also just saves the patient having to have two trips to the OR by being able to test people in the office.
*Video transcript is AI-generated and reviewed by Urology Times® editorial staff.
