The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Percutaneous posterior tibial nerve stimulation for overactive bladder syndrome. Further recommendations have been made as part of the clinical guideline on urinary incontinence in women published in September 2013. Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. The interventional procedure guidance on percutaneous posterior tibial nerve stimulation for overactive bladder syndrome remains current, and should be read in conjunction with the clinical guideline.
The symptoms of overactive bladder syndrome include the need to urinate often and without much warning (frequency), and urge incontinence (the strong need to urinate followed by an inability to stop passing urine). It is caused by the bladder muscle contracting before the bladder is full. Percutaneous posterior tibial nerve stimulation (PTNS) for overactive bladder involves inserting a fine needle into a nerve just above the ankle. A mild electric current is passed through the needle and carried to the nerves that control bladder function.
A70.4 Insertion of neurostimulator electrodes into peripheral nerve
Z12.2 Posterior tibial nerve
In addition the ICD-10 code N32.8 Other specified disorders of bladder would be recorded.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.