Astellas - Voiding Dysfunction Articles


  • AUA 2020: The Use of Peripheral Tibial Nerve Stimulation as an Alternative Treatment for Overactive Bladder/Incontinence

    ( Nurse practitioner Lynn Allmond, FNP-BC, presented on neuromodulation, specifically PTNS (Laborie) and PTNM Medtronic at the virtual AUA 2020 conference. In these 2 modalities, neuromodulation provides indirect stimulation to the sacral nerve plexus via the tibial nerve, a mixed sensory-motor nerve that runs from the spinal roots L4-S3 to innervate the bladder & urethral sphincter. Although the exact mechanism for this treatment of overactive bladder symptoms (urgency, frequency, urgency incontinence) is not known, it is thought that stimulation affects the nerves that influence the bladder.  It works through receptors in the spinal cord and by activating somatosensory afferent fibers. Contraindications are pregnancy, presence of a pacemaker or defibrillator, lower extremity nerve damage.

    The procedure involves the insertion of a 34-gauge needle above the medial malleolus, as is shown in this photo: 


    Lead wires are connected to the needle and stimulator, and grounding pad attached to the instep of the same foot.  The current setting (mA) is increased until there is a sensory or motor response (flexion of the great toe or fanning of toes 2-5; or tingling at ball of foot). The sensation should be comfortable, not painful.  Treatment is for 30 minutes, once a week sessions for 12 weeks. Ms. Allmond presented the results of the PTNS research: SUmiT efficacy Trial which was a double-blind, randomized vs SHAM trial of 220 patients and the 3-years follow-up study.3 There is also a prospective study that evaluated the efficacy of PTNM treatment.  Ms. Allmond has been tracking overactive bladder symptom outcomes in her patient population and has seen similar efficacy with the PTNS treatment.

    Presented by: Lynn M. Allmond, FNP-BC, Department of Surgery, Urology, Augusta University, Agusta, GA

    Written by:  Diane Newman, DNP, ANP-BC, Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health


    1. Kobashi et al. A prospective study to evaluate efficacy using the NURO™ percutaneous tibial neuromodulation system in drug-naïve patients with overactive bladder syndrome (OAB). Urology. 2019 Sep;131:77-82. doi: 10.1016/j.urology.2019.06.002. Epub 2019 Jun 11. PMID:31199966
    2. Peters et al.   Sustained therapeutic effects of percutaneous tibial nerve stimulation: 24-month results of the STEP study.   Neurourol Urodyn. 2013 Jan;32(1):24-9. doi: 10.1002/nau.22266.
    3. Peters et al.  Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010 Apr;183(4):1438-43. doi: 10.1016/j.juro.2009.12.036.
    Published May 26, 2020
  • Complications & Adverse Events – External Urinary Catheters

    An external urine collection device (EUCD) may be external and less invasive but they are not free of risks. Complications and adverse effects include skin lesion/ulceration and breakdown from pressure necrosis and moisture, urethral fistula or very rarely, gangrene of the penis. The majority of complications involve perineal/genital skin issues, primarily occurring in 15-30% of male patients and involve external penile shaft problems.

    Written by: Diane K. Newman, DNP, ANP-BC, FAAN
    References: 1. Al-Awadhi, N. M., N. Al-Brahim, M. S. Ahmad, and E. Yordanov. "Giant fibroepithelial polyp of the penis associated with long-term use of condom catheter. Case report and literature review." The Canadian journal of urology 14, no. 4 (2007): 3656-3659.
    2. Banerji, John S., Sanjeev Shah, and Nitin S. Kekre. "Fibroepithelial polyp of the prepuce: A rare complication of long-term condom catheter usage." Indian journal of urology: IJU: journal of the Urological Society of India 24, no. 2 (2008): 263.
    3. Beeson, Terrie, and Carmen Davis. "Urinary management with an external female collection device." Journal of Wound, Ostomy, and Continence Nursing 45, no. 2 (2018): 187.
    4. Bycroft, J., R. Hamid, and P. J. R. Shah. "Penile erosion in spinal cord injury–an important lesson." Spinal cord 41, no. 11 (2003): 643-644.
    5. Golji, Hossein. "Complications of external condom drainage." Paraplegia 19, no. 3 (1981): 189-197.
    6. Grigoryan, Larissa, Michael S. Abers, Quratulain F. Kizilbash, Nancy J. Petersen, and Barbara W. Trautner. "A comparison of the microbiologic profile of indwelling versus external urinary catheters." American journal of infection control 42, no. 6 (2014): 682-684.
    7. Harmon, Christopher B., Suzanne M. Connolly, and Thayne R. Larson. "Condom-related allergic contact dermatitis." The Journal of urology 153, no. 4 (1995): 1227-1228.
    8. Newman, D. K. "Devices, products, catheters, and catheter-associated urinary tract infections." Core curriculum for urologic nursing. 1st ed. Pitman: Society of Urologic Nurses and Associates, Inc (2017): 439-66.
    9. Newman, Diane K., and Alan J. Wein. "External Catheter Collection Systems." In Clinical Application of Urologic Catheters, Devices and Products, pp. 79-103. Springer, Cham, 2018.
    10. Milanesi, Nicola, Gastone Bianchini, Angelo Massimiliano D'ERME, and Stefano Francalanci. "Allergic reaction to condom catheter for bladder incontinence." Contact dermatitis 69, no. 3 (2013): 182-183.
    Published April 17, 2020
  • Same Sized Three-Way Indwelling Urinary Catheters from Various Manufacturers Present Different Irrigation and Drainage Properties - Beyond the Abstract

    The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Every clinical situation leads to a particular kind of hematuria, which can be managed wh a greater or lesser irrigation flow in order to prevent complications.
    Published February 24, 2020
  • Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties.

    The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market.

    Published January 26, 2020
  • SUFU 2020: Can Urodynamic Parameters Predict the Need to Catheterize after Intravesical Injections of Onabotulinum Toxin A for Overactive Bladder

    Scottsdale, Arizona ( This was a retrospective review to assess assessed whether pre-operative UDS findings can predict the need to catheterize (intermittently or indwelling) after Botox A injections.
    Published February 29, 2020
  • SUFU 2020: Evaluation of Independent Predictors of Compliance to Continued Therapy With Intradetrusor Botox Injection

    Scottsdale, Arizona ( Through a retrospective review of patients who underwent Botox injections, Dr. Gary Lemack and his team examined demographic and urodynamic factors that would be predictive of continuing therapy. The study dates took place between December 2007 to September 2016 as there is a paucity of literature examining predictors for continuing therapy with intradetrusor injections of onabotulinum toxin A (Botox) for refractory urgency/urge incontinence (U/UI).
    Published February 28, 2020