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).
Why patients choose us
- 01
A nurse-led continence clinic with volume
Not a general urology list. A named PTNS specialist nurse in a dedicated continence clinic running weekly PTNS lists.
- 02
The right step at the right time
PTNS is not always the answer. If antimuscarinics were never properly trialled, or Botox is a better fit, we say so before you commit to 12 weeks.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private PTNS costs in London.
Indicative ranges across our partner London units. Send the bladder history and we quote firm figures across two or three options.
In short
A full 12-week PTNS course in our London network: £1,400 to £2,400, no surgery, home immediately.
| Item | Indicative range | Typical duration | Frequency |
|---|---|---|---|
| Initial urogynaecology or urology consultation | £250–£450 | 45–60 min | Same visit |
| Single PTNS session (weekly) | £120–£220 | 30 min | Same visit |
| Full 12-week initial PTNS course | £1,400–£2,400 | 12 x 30 min | Weekly |
| Monthly maintenance session (responders) | £150–£280 | 30 min | Monthly |
| Year 1 total (course plus maintenance) | £2,500–£4,500 | ~18 sessions | Over 12 months |
| Bladder diary review and second-opinion planning | £200–£400 | 30 min | 48 hours |
Prices vary by hospital, by whether sessions are bundled or paid as you go, and by whether an initial consultant review is needed. We come back with a firm quote within one working day.
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.
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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.
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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.
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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.
The course
Twelve weekly sessions, then maintenance.
One team from first message to week-12 review and monthly maintenance, in the same nurse-led continence clinic every visit.
Phase 1 · Before your course
Concierge, off-stage for you
Phase 2 · Each weekly session
30 minutes, no downtime
Phase 3 · After week 12
Response review, maintenance
- 01
Before
You send us the bladder history
A short, confidential form. Symptoms, medications already tried, any bladder diary or urodynamics, and how long you have been coping with urgency.
- 02
Before
We come back with a recommendation
Within one working day: whether PTNS fits, or whether mirabegron, Botox or sacral neuromodulation is the better call. Indicative price. An honest read either way.
- 03
Before
We book the initial assessment
Usually within one to two weeks. A urogynaecologist or urologist consultation, urinalysis to exclude infection, and a bladder diary if not already done.
- 04
Each session
Arrival for a weekly session
Arrival at the nurse-led continence clinic. Shoes and socks off, ankle exposed. No sedation, no fasting, drive yourself home afterwards.
- 05
Each session
The PTNS session itself
30 minutes. A fine single-use needle just above the ankle, a surface electrode on the arch, low-frequency stimulation titrated until the big toe flexes.
- 06
Each session
Straight back to your day
No downtime. Most people feel a mild tingling for an hour and nothing else. You return weekly for 12 sessions.
- 07
After week 12
Week 12 assessment and maintenance
A repeat bladder diary and symptom score at week 12. Responders move to monthly maintenance sessions, typically for several years.
Typical initial course: 12 weeks. Week-12 response: 60 to 80%. Maintenance: monthly, ongoing.
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.
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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.
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Urge urinary incontinence
Sudden compelling urgency followed by involuntary leakage, with or without an obvious trigger. PTNS reduces both urgency episodes and leaks.
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Mirabegron intolerance or contraindication
Rising blood pressure, tachycardia or interaction with existing cardiovascular medications, leaving few pharmacological options.
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Frail elderly patients
Antimuscarinic cognitive side effects are a real concern in older adults. PTNS has no systemic effects and no drug interactions.
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Patient wants a non-surgical route
Wanting to try a proven, low-risk therapy before considering intravesical Botox or an implanted sacral neuromodulator.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Maintenance sessions
Responders taper to one session every 3 to 4 weeks. Skipping maintenance leads to gradual return of symptoms within a few months.
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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.
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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.
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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.
Our vetted London network
Where you can have PTNS privately in London, we picked them.
A small panel of PTNS-accredited nurse specialists in central London units. Not listed publicly, introductions are made privately once we understand your history.
Units we work with
Where private PTNS is run in London.
- HCA The Wellington Hospital Urogynaecology
- Cromwell Hospital (BUPA)
- University College London Hospital Private
- Chelsea and Westminster Private
- The London Clinic
- Guy's and St Thomas' Private Healthcare
- King's College Hospital Private
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PTNS-accredited specialist nurses running weekly continence lists
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BAUS and BSUG member consultants supervising the pathway
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Bladder diary and validated OAB symptom scoring at baseline, week 6 and week 12
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Clear escalation pathway to Botox, sacral neuromodulation or urodynamic re-assessment
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.
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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.
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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.
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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.
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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.
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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.
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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.
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Rare infection
Single-use sterile needle each session and skin cleaned with alcohol wipe. Infection at the site is very uncommon.
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Not for pacemakers or pregnancy
Implanted pacemakers, defibrillators or pregnancy are contraindications. Tell the nurse about any implanted electronic device before session 1.
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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.
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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.
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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.
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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.
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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.
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Mirabegron
Beta-3 agonist, better tolerated than antimuscarinics. Expensive, needs blood pressure monitoring, and contraindicated in uncontrolled hypertension. Often tried before PTNS.
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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.
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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.
- 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.
- 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.
- 03 Outcome
Week 12 response assessment
Formal responder classification: moderate to marked improvement, mild improvement or non-responder. Decides whether you move to maintenance.
- 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
Cover for PTNS varies by insurer, and is usually funded for the 12-week course when antimuscarinics or mirabegron have failed. We confirm cover before booking.
Frequently asked
Everything we get asked about PTNS.
Quick answers on pain, insurance, maintenance, Botox, paediatrics and pregnancy.
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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.
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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. We confirm cover with your insurer before you book.
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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.
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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.
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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. It is not something we arrange privately for children; a paediatric urology referral in an NHS specialist centre is the right route.
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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.
Speak to the team
Tell us the bladder history. We come back within a working day.
One short form: symptoms, medications tried, and where in London suits you. We reply with a shortlist of two or three PTNS clinics, firm prices and honest thoughts on whether PTNS is the right next step for you.
Related treatments
Looking for something else?
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Sacral neuromodulation (InterStim)
Implanted S3 stimulator for OAB unresponsive to PTNS or Botox.
Learn more -
Botox for overactive bladder
Intravesical botulinum toxin for refractory OAB, lasting 6 to 9 months.
Learn more -
Bulkamid urethral bulking
Injectable bulking agent for stress urinary incontinence.
Learn more -
Urethral dilation
Gentle dilation for urethral stricture and voiding difficulty.
Learn more -
Menopause
The condition guide, including urinary symptoms and treatment.
Learn more