Technique for Implantable Tibial Nerve Stimulator Placement.

AIM/INTRODUCTION: Percutaneous posterior tibial nerve stimulation is an office-based treatment for urinary urgency with and without incontinence. However, given the need for ongoing therapy for patients with urgency incontinence, devices that allow for at-home stimulation of the posterior tibial nerve have been developed. Implantable tibial neuromodulation (iTNM) devices offer a permanent solution to in-office percutaneous stimulation. Currently, a subfascial iTNM system is approved for men and women with urinary urgency with and without incontinence. Given the recent approval of this device, the objective of this surgical video is to discuss the technique for placement of subfascial iTNM stimulator and considerations for postoperative care.

METHODS: This is a surgical video of a subfascial iTNM placed in a female patient with urgency urinary incontinence. Written informed consent was obtained.

RESULTS: After watching this video, surgeons will understand the components of the subfascial device system, patient selection considerations, surgical technique for placement, and postoperative care.

CONCLUSIONS: The subfascial iTNM is a permanent solution to office-based percutaneous tibial nerve stimulation. It offers patients an evidence-based therapy with the flexibility of at-home stimulation sessions using an external wearable battery. This video highlights the subfascial stimulator device system and educates surgeons on its placement and perioperative management.