Sacral nerve stimulation and PTNS in Salt Lake City
Sacral nerve stimulation and PTNS work on the nerves involved in bladder control. They can reduce urgency, frequency, and urgency leaking in selected patients. Elisabeth Ferlic, MD, is a board-certified urologist with fellowship training in voiding dysfunction and female pelvic medicine. Her practice evaluates these concerns in women and men.
Ask about treatment options or call 435-344-4760.
Elisabeth Ferlic, MD
Board-certified urologist · Fellowship-trained in voiding dysfunction and female pelvic medicine
In this guide
- Alternatives to nerve stimulation
- How nerve stimulation calms the bladder
- Why see Dr. Ferlic for nerve stimulation
- What are my options?
- Sacral neuromodulation and PTNS compared
- Who nerve stimulation helps
- How to prepare
- What happens during treatment
- Recovery and results
- Risks and side effects
- What happens at the first visit?
- Frequently asked questions
Alternatives to nerve stimulation
Nerve stimulation is one option among several, and it's rarely the first.
Steps that usually come first
- Conservative careBladder retraining, fluid and diet changes, and pelvic floor therapy come first. The overactive bladder page covers them.
- MedicationIt helps some people and is a reasonable step to try or to stay on.
Another procedure
- Bladder BotoxBladder Botox relaxes the bladder muscle directly and is repeated about every six months.
PTNS tends to suit people who don't want an implant and can commit to weekly visits. Sacral neuromodulation tends to suit people who want long-term control without regular appointments, and it's the only one of these options that also helps with emptying. An evaluation helps determine which treatment fits your symptoms and medical history.
Reach out to the practice or call 435-344-4760.
How nerve stimulation calms the bladder
Your bladder and brain send signals back and forth along nerves that pass through the sacrum, the flat bone at the base of your spine. In overactive bladder, those signals misfire. The bladder sends a "urgent" message when it isn't full, or squeezes without warning.
Neuromodulation is the clinical term for steadying those signals with mild electrical pulses. No medication is involved. Two established therapies deliver it.
Sacral neuromodulation, also called sacral nerve stimulation, uses a small device implanted under the skin of the upper buttock. A thin wire, called a lead, rests beside a sacral nerve and delivers a gentle pulse. People often call it a bladder pacemaker. Axonics and InterStim are examples of sacral neuromodulation systems. The available device and its suitability need confirmation before treatment.
PTNS (percutaneous tibial nerve stimulation) reaches the same nerves from farther away. The tibial nerve runs from the ankle up the leg and joins the sacral nerves. During a session, a very thin needle electrode near your ankle sends pulses along that pathway for 30 minutes. Nothing is implanted.
Why see Dr. Ferlic for nerve stimulation
Dr. Ferlic is a urologist with fellowship training in voiding dysfunction and female pelvic medicine. That fellowship included neuro-urology, the study of how nerves and the bladder work together. Sacral nerve stimulation and PTNS act on that same connection.
Her prior practice included sacral neuromodulation. The choice between therapy, medication, Botox, and stimulation depends on the evaluation. Confirm which procedure and device are available in this practice before scheduling. Read more about Dr. Ferlic, or see how this fits into women's pelvic health and men's urology.
What are my options?
A starting point for the conversation, not a prescription. Your evaluation decides what fits.
You'd rather avoid an implant
And you can commit to weekly visits
PTNS
12 weekly 30-minute office sessions, then about one a month
You want control without regular visits
And you're open to a minor procedure and an implant
Sacral neuromodulation
A trial first, then a small stimulator placed under the skin
Retention without a blockage
In selected cases, a bladder that doesn't empty well
Sacral neuromodulation for emptying
The only option here that also helps with emptying
Urgency after first steps didn't help
Bladder retraining, pelvic floor therapy, and medication weren't enough
Bladder Botox
Another option that relaxes the bladder muscle directly
Sacral neuromodulation and PTNS compared
| Sacral neuromodulation (Axonics, InterStim) | PTNS | |
|---|---|---|
| What it is | A small implanted stimulator and lead | A thin needle electrode near the ankle, used only during the session |
| Time commitment | A one-to-two-week trial, then one outpatient implant procedure | 12 weekly 30-minute office sessions, then about one a month |
| How you know it works | The trial shows you before anything permanent is placed | Most people who respond notice a change by week five to seven |
| Upkeep | Occasional settings checks; a battery that lasts years | Maintenance sessions for as long as you want the benefit |
| Treats | Urgency, frequency, urgency leaking, and some emptying problems | Urgency, frequency, and urgency leaking |
| Main trade-off | A minor surgical procedure and an implant | Regular office visits |
Sacral neuromodulation (Axonics, InterStim)
- What it is
- A small implanted stimulator and lead
- Time commitment
- A one-to-two-week trial, then one outpatient implant procedure
- How you know it works
- The trial shows you before anything permanent is placed
- Upkeep
- Occasional settings checks; a battery that lasts years
- Treats
- Urgency, frequency, urgency leaking, and some emptying problems
- Main trade-off
- A minor surgical procedure and an implant
PTNS
- What it is
- A thin needle electrode near the ankle, used only during the session
- Time commitment
- 12 weekly 30-minute office sessions, then about one a month
- How you know it works
- Most people who respond notice a change by week five to seven
- Upkeep
- Maintenance sessions for as long as you want the benefit
- Treats
- Urgency, frequency, and urgency leaking
- Main trade-off
- Regular office visits
Who nerve stimulation helps
Both therapies are for women and men who've already tried the first steps for overactive bladder: bladder retraining, pelvic floor therapy, and often a medication. If those steps didn't help enough, or the side effects weren't worth it, nerve stimulation is one of the next options. Bladder Botox is another option.
They help with sudden urges, frequent bathroom trips, and urgency leaking, one of several kinds of urinary incontinence.
Sacral neuromodulation can also treat selected cases of retention without a blockage. Neurogenic bladder needs a separate assessment; a neurologic diagnosis can change whether stimulation is appropriate.
Who it isn't for
Neither therapy treats stress incontinence, the leaking that comes with a cough, a sneeze, or a lift. They also don't fix a bladder that can't empty because of a blockage, such as an enlarged prostate.
Before PTNS, tell your clinician about any pacemaker or implanted defibrillator, bleeding tendency, pregnancy or pregnancy plans, and nerve damage near the treatment area. Device-specific restrictions determine whether treatment is appropriate.
How to prepare
An evaluation considers your history and symptoms, with an examination, urine testing, or a bladder scan when needed.
Before a sacral neuromodulation trial, you do three things:
- Keep a bladder diary for at least three days. It's the baseline your trial is measured against.
- Bring a full medication list, including blood thinners and supplements.
- Plan for the day. If sedation is used, you'll get instructions about eating and drinking, and you'll need a ride home.
PTNS is commonly performed with the lower leg accessible. Confirm any preparation and device restrictions with the treating team.
Recovery and results
After a sacral neuromodulation procedure, follow the treating team's instructions about lifting, bathing, exercise, and wound care. The device settings can be adjusted if stimulation is uncomfortable or symptoms change.
Battery life, charging needs, replacement procedures, and MRI restrictions depend on the model. Ask for the device information rather than assuming every implant has the same requirements.
PTNS generally involves little recovery, but the repeated visits are part of the treatment commitment. Either approach manages symptoms; benefit and ongoing care needs vary.
Risks and side effects
Complications from sacral neuromodulation are uncommon, but it's still a surgical implant. The main risks are pain at the implant site, infection, a lead that shifts out of position, uncomfortable stimulation, and a device that stops working. Reprogramming solves some of these problems; others need a second procedure. The system can be removed if you ever want it out.
Whether you can have an MRI depends on your model, so tell every imaging center about the implant before a scan. Airport security can detect the device, so let the screener know.
PTNS has very few side effects. The most common are temporary soreness or skin irritation where the needle went in.
Call the office if you notice fever, redness, or drainage at an incision, or if your symptoms suddenly return.
What treatment can address
- Sudden urges and frequent bathroom trips
- Urgency leaking
- Selected cases of retention without a blockage, with sacral neuromodulation
What to weigh first
- Neither therapy treats stress incontinence or a blockage
- Sacral neuromodulation is a surgical implant with its own risks
- MRI access depends on the device model
- PTNS means repeated office visits
- A neurologic diagnosis needs a separate assessment
What happens at the first visit?
The visit starts with what has changed and what you want help with. Any treatment and follow-up plan is specific to you.
Talk through your symptoms
Bring your concerns, medication list, and relevant medical history.
Decide what needs checking
Testing depends on your symptoms and history, and some concerns need a separate workup.
Discuss a plan and follow-up
Review benefits, risks, alternatives, and what to watch for.
Before you schedule
Ask which appointments are available and whether your concern suits a video visit or needs an in-person evaluation.
Here’s what our great patients say
What is the difference between Axonics and InterStim?
Both are sacral neuromodulation systems, and both work the same way: a small stimulator sends mild pulses to a sacral nerve through a thin lead. They differ in size, in whether the battery is rechargeable or recharge-free, in how long the battery lasts, and in their MRI rules. Ask which model is recommended and request its device-specific information before a trial or implant.
Can I have an MRI with a sacral nerve stimulator?
It depends on the device. Many current systems allow MRI scans under specific conditions, and some older ones don't. Tell every imaging center about your implant before a scan, and bring your device information with you.
How long does PTNS take to work?
Most people who respond notice a change after five to seven weekly sessions. The standard course is 12 sessions, and the result is judged at the end. If it worked, maintenance sessions about one a month keep the benefit going.
Does nerve stimulation work for men?
Yes. Overactive bladder affects millions of men, and sacral nerve stimulation and PTNS are used for both sexes. In men, the prostate is checked first, because a blockage needs a different treatment.
Does insurance cover sacral nerve stimulation or PTNS?
Coverage depends on your insurer, diagnosis, procedure, and the practice's participation. Ask your insurer about authorization requirements, treatment limits, and out-of-pocket cost before scheduling.
Talk with the practice about nerve stimulation
Contact the practice or call 435-344-4760 to ask about availability and the next step.
Ask which therapies and devices are available and whether an examination or additional testing is needed first.
This page is for general education and is not medical advice.