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Urogynaecology · London

PTNS for overactive bladder - London.

A drug-free, non-surgical treatment for urgency, frequency and urge incontinence unresponsive to antimuscarinics or mirabegron. Twelve weekly 30-minute sessions in a nurse-led continence clinic, no downtime, and a NICE-recommended pathway (IPG362).

A stethoscope on a clinical desk

Indicative pricing

What private PTNS costs in London.

Indicative ranges across UK London units.

In short

£1,400 to £2,400, no surgery, home immediately.

Item Indicative range
Initial urogynaecology or urology consultation £250–£450
Single PTNS session (weekly) £120–£220
Full 12-week initial PTNS course £1,400–£2,400
Monthly maintenance session (responders) £150–£280
Year 1 total (course plus maintenance) £2,500–£4,500
Bladder diary review and second-opinion planning £200–£400

Prices vary by hospital, by whether sessions are bundled or paid as you go, and by whether an initial consultant review is needed.

What PTNS is

A fine needle at the ankle, quieting an overactive bladder.

Percutaneous tibial nerve stimulation is a form of peripheral neuromodulation. It borrows nothing from drugs, needs no surgery, and works with your own nervous system.

  • A single-use needle just above the ankle

    A fine 34-gauge needle is inserted about 5cm above the medial malleolus and angled toward the tibial nerve, with a surface electrode on the arch of the foot.

  • Retrograde modulation of the sacral centre

    Low-frequency stimulation travels retrogradely up the tibial nerve and into the sacral micturition centre, reducing detrusor overactivity and calming urgency signals.

  • NICE-recommended for OAB (IPG362)

    Recommended by NICE for overactive bladder unresponsive to lifestyle changes and pharmacological therapy, delivered in a supervised nurse-led continence clinic.

Who benefits

Who PTNS is the right step for.

The overactive bladder profiles we see most, and the red flags that mean urology assessment before any PTNS booking.

  • Urgency and frequency unresponsive to medication

    Antimuscarinics such as oxybutynin, tolterodine or solifenacin have failed, are not tolerated, or caused unacceptable dry mouth and constipation.

  • Urge urinary incontinence

    Sudden compelling urgency followed by involuntary leakage, with or without an obvious trigger. PTNS reduces both urgency episodes and leaks.

  • Mirabegron intolerance or contraindication

    Rising blood pressure, tachycardia or interaction with existing cardiovascular medications, leaving few pharmacological options.

  • Frail elderly patients

    Antimuscarinic cognitive side effects are a real concern in older adults. PTNS has no systemic effects and no drug interactions.

  • Patient wants a non-surgical route

    Wanting to try a proven, low-risk therapy before considering intravesical Botox or an implanted sacral neuromodulator.

  • Medication-averse patients

    Prefer to avoid long-term daily tablets. PTNS is drug-free, uses a fine needle only, and needs one visit a week for 12 weeks.

  • Post-menopausal overactive bladder

    Urgency and nocturia rising through the menopause, often alongside vaginal atrophy. PTNS pairs well with topical oestrogen and pelvic-floor work.

  • Red flag: visible blood, pain, retention

    Visible haematuria, bladder pain, recurrent infection or a poorly emptying bladder needs urgent urological assessment, not a PTNS booking.

Course detail

The 12-week course, and what sits either side of it.

What each element of the pathway actually involves, plus the neighbouring options if PTNS does not deliver.

  • Standard percutaneous PTNS

    A fine 34-gauge needle inserted 5cm above the medial malleolus, angled toward the tibial nerve, with a surface ground electrode on the arch of the foot.

  • Titrating the stimulation

    Low-frequency current is slowly increased until the big toe flexes or fans, confirming correct needle placement. Sensation is a mild pulsing, not painful.

  • The 12-week initial course

    One 30-minute session per week for 12 consecutive weeks. Skipping sessions delays the response and reduces the chance of benefit.

  • Bladder diary and symptom scoring

    A 3-day bladder diary before session 1, again at week 6, and at week 12. ICIQ-OAB or OAB-q short form scores measure real change.

  • Maintenance sessions

    Responders taper to one session every 3 to 4 weeks. Skipping maintenance leads to gradual return of symptoms within a few months.

  • Transcutaneous TTNS (surface only)

    A needle-free version using surface electrodes on the ankle. Cheaper and home-usable, but evidence for OAB is weaker than for percutaneous PTNS.

  • Botox intravesical (when PTNS fails)

    If PTNS has not helped by session 8 to 10, intravesical botulinum toxin under local anaesthetic is a next step, lasting 6 to 9 months per treatment.

  • Sacral neuromodulation (InterStim)

    An implanted stimulator at the S3 nerve root, offered when PTNS and Botox have both failed. Durable but invasive, and requires MRI-compatible planning.

Outcomes

What the evidence actually says.

The SUmiT randomised trial and subsequent long-term studies are the strongest data points, alongside real-world UK continence-clinic audits.

  • SUmiT trial (Peters et al)

    Landmark randomised sham-controlled trial: 55% of PTNS patients reported moderate-to-marked improvement at week 12, versus 21% on sham stimulation.

  • Sustained benefit with maintenance

    Follow-up studies show benefit is maintained at 12 and 24 months when patients continue monthly maintenance sessions. Symptoms drift back when maintenance stops.

  • Comparable to antimuscarinics

    Head-to-head trials show PTNS delivers comparable symptom improvement to tolterodine and other antimuscarinics, without cognitive side effects or dry mouth.

Safety and side effects

What to expect, honestly.

PTNS is one of the safest treatments in urology. The real considerations are the weekly time commitment, whether you respond, and the long-term maintenance plan.

  • Almost painless

    The needle is finer than a standard acupuncture needle. Most people feel a small scratch on insertion and a pulsing sensation during stimulation, nothing more.

  • No systemic side effects

    PTNS is peripheral neuromodulation, not a drug. No dry mouth, no constipation, no cognitive fogging, no blood pressure changes, no interactions with your other medications.

  • Bruising at the ankle

    A small bruise at the needle site in perhaps 5% of sessions. It settles in a few days and never limits the next appointment.

  • Rare infection

    Single-use sterile needle each session and skin cleaned with alcohol wipe. Infection at the site is very uncommon.

  • Not for pacemakers or pregnancy

    Implanted pacemakers, defibrillators or pregnancy are contraindications. Tell the nurse about any implanted electronic device before session 1.

  • Weekly commitment matters

    Missed or delayed sessions reduce the chance of response. Plan the 12-week block around holidays and busy work periods before starting.

  • Not everyone responds

    Around 40% of patients see little or no meaningful improvement. If sessions 6 to 8 show no change, we move on rather than complete a fruitless course.

  • Maintenance is ongoing

    PTNS suppresses symptoms while treatment continues. If maintenance stops, urgency and frequency gradually return over a few months. Plan for years of monthly visits.

  • What to do between sessions

    Keep to your bladder diary, cut caffeine and fizzy drinks, and continue pelvic-floor exercises. PTNS works best alongside lifestyle change, not instead of it.

Compared to alternatives

PTNS is one option on a ladder.

A quick, honest comparison of the treatments you will hear about in an OAB clinic.

  • Antimuscarinics (oxybutynin, tolterodine, solifenacin)

    First-line pharmacological therapy. Effective for many, but dry mouth, constipation and cognitive side effects, especially in the elderly, drive many patients to stop within 6 months.

  • Mirabegron

    Beta-3 agonist, better tolerated than antimuscarinics. Expensive, needs blood pressure monitoring, and contraindicated in uncontrolled hypertension. Often tried before PTNS.

  • Intravesical Botox

    Bladder injection under local anaesthetic. More powerful than PTNS for many patients, lasts 6 to 9 months per treatment, but real risk of temporary urinary retention needing self-catheterisation.

  • Sacral neuromodulation (InterStim)

    An implanted stimulator at the S3 nerve root. Durable, drug-free, powerful, but invasive, requires a trial phase and a permanent implant. Reserved for PTNS or Botox failures.

Reading your PTNS results

Your PTNS review in four parts. Read the last one first.

Whichever clinic you attend, the results your continence nurse and consultant work through keep to the same shape.

A quiet reminder

A bladder diary is not paperwork, it is the treatment.

A proper 3-day diary at baseline, week 6 and week 12 is the only way to know whether PTNS is really working for you.

  1. 01 Baseline

    Bladder diary and symptom score at week 0

    Voids per 24 hours, urgency episodes, incontinence episodes and pad use, plus ICIQ-OAB or OAB-q short form score. Your starting line.

  2. 02 Progress

    Interim check at week 6

    Repeat 3-day diary and symptom score. A meaningful drop by week 6 predicts a strong week-12 result; no change at all prompts a rethink.

  3. 03 Outcome

    Week 12 response assessment

    Formal responder classification: moderate to marked improvement, mild improvement or non-responder. Decides whether you move to maintenance.

  4. 04 Plan

    Maintenance schedule or alternative

    Read this first: monthly maintenance interval, next booking, or a plan to switch to Botox or sacral neuromodulation if PTNS did not work.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for PTNS varies by insurer, and is usually funded for the 12-week course when antimuscarinics or mirabegron have failed.

Frequently asked

Everything we get asked about PTNS.

Quick answers on pain, insurance, maintenance, Botox, paediatrics and pregnancy.

  • Is PTNS painful?

    Almost never. The needle is finer than a standard acupuncture needle and is inserted just above the inside of the ankle in a few seconds. During the 30-minute session you feel a mild pulsing sensation and, at the correct current, your big toe flexes gently. Most people read or use their phone through the session.

  • Does private health insurance cover PTNS?

    Cover varies. PTNS is NICE-recommended for overactive bladder unresponsive to lifestyle and medication (IPG362), and most major UK insurers, including Bupa, AXA Health and Vitality, will fund a 12-week course when medically indicated and with a consultant referral. Maintenance sessions are covered less consistently.

  • Will I need maintenance sessions forever?

    Responders typically stay on monthly maintenance sessions for 5 to 10 years or more. PTNS suppresses overactive bladder signals while treatment continues; if you stop, symptoms drift back over a few months. Some patients slowly stretch the interval to 6 or 8 weeks, others need to stay monthly to hold the benefit.

  • Is Botox better than PTNS?

    They work in different ways. Intravesical Botox is more powerful for many patients and lasts 6 to 9 months per treatment, but it is a bladder injection under local anaesthetic and carries a real risk of temporary urinary retention needing self-catheterisation. PTNS is much less invasive, has almost no side effects, but needs a weekly commitment for 12 weeks and ongoing maintenance. Many patients try PTNS first.

  • Is PTNS available for children?

    PTNS is used off-licence in specialist paediatric urology centres for children with non-neurogenic overactive bladder unresponsive to standard urotherapy and antimuscarinics.

  • Can I have PTNS during pregnancy?

    No. Pregnancy is a contraindication to PTNS because the effects of neuromodulation on the developing pregnancy have not been established. If you become pregnant partway through a course, sessions are paused and can be restarted after delivery.

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