Tibial neuromodulation is a minimally invasive therapy used to manage several lower urinary tract disorders, including overactive bladder, urinary urgency, frequency, and urge incontinence. The technique works by stimulating the posterior tibial nerve near the ankle, which shares spinal pathways (S2–S4) with the bladder and pelvic floor. By modulating these neural circuits, tibial neuromodulation helps normalize abnormal signaling between the bladder and brain.

Clinical studies have shown tibial neuromodulation to be effective in reducing urgency episodes, daytime frequency, nocturia, and incontinence, with response rates often comparable to first-line medications—but without systemic side effects such as dry mouth, constipation, or cognitive changes. This makes it especially appealing for patients who cannot tolerate or prefer to avoid pharmacologic therapy.

Tibial neuromodulation therapy can be delivered in two different ways. The first method is called PTNS – or Percutaneous Tibial Neurododulation which is delivered through a series of weekly 30-minute sessions in the office where the tibial nerve is stimulated through a fine needle while seated. The other option – called Implanted Tibial Nerve Stimulation – is offered by a very small group of urologists including Dr. McCauley.  This option eliminates the need for regular clinic visits by implanting a small stimulation device during an outpatient surgical procedure that delivers stimulation of the nerve on a schedule or through an external controller.

From a care-pathway perspective, Tibial Neurododulation provides important options typically offered after behavioral therapies (like bladder training and pelvic floor exercises) have not been successful.