After failing conservative treatment alternatives for these patients such as behavioral modification and
pharmaceutical management, intravesical Botulinum toxin injection, sacral neuromodulation(SNM) and
percutaneous tibial nerve stimulation (PTNS) are well-established third-line treatment options. SNM and PTNS,
have not seen any significant improvement of the devices over the last decade or since FDA approval in 1997
In this study a new, battery - free implantable tined lead device ( StimRouter™ by Bioness ) in a multi - center study
is evaluated

From May 2019, 7 consecutive patients with urgency incontinence and detrusor over activity underwent a
procedure under local anesthesia in which a battery - free tined lead electrode was implanted on the medial side
of the ankle ( Figure 1 ). This lead was implanted by the same surgeon in all cases through a single 5 mm incision
and after the appropriate response of electrical stimulation, ( flexion of the first toe and paresthesia of the foot )
was looked. After identifying correct position, the lead was inserted through Seldinger technique and after a
final electrical check of the appropriate responses, subcutaneously tunneled for 10 cm in the proximal direction
of the medial side of the ankle. The total procedure time was 15 - 25 minutes. Patients were advised to stimulate
their tibial nerve with a hand - held remote at home for an hour per day. A hand - held remote allows patients to
control their symptoms by delivering gentle stimulating pulses to the Tibial Nerve to reduce the chronic urge to
urinate .

All 7 patients reported an improvement in the urgency and incontinence episodes and a significant reduction of
incontinence - pad use after treatment . In addition, both day - time as well as night - time frequency was reduced in
all implanted patients ( Figure1 )

Our multi center data presented here are the first follow up data on feasibility and effect of the battery - free
implantable tibial nerve stimulation device ( Stimrouter ) for the treatment of urinary incontinence. There were no
adverse events and all implanted patients reported a significant improvement in urgency and incontinence
episodes as well as pad use and day - time and night - time frequency .

We can conclude that tibial nerve stimulation with Stimrouter could be a very promising therapy for patients with refractory idiopathic OAB and hope to develop this technology as soon as possible .