**7.5 Percutaneous posterior tibial nerve stimulation**

Percutaneous posterior tibial nerve stimulation (PTNS) is the least invasive surgical method used in management of refractory symptoms of urgency and urge incontinence. It is mediated by retrograde stimulation of the sacral nerve plexus. The posterior tibial nerve contains mixed sensory motor nerve fibres that originate from the same segment in the spinal cord as the nerves to the bladder and pelvic floor [23, 24].

#### **7.6 Long term catheterisation**

Patients with severe over active bladder symptoms that is unresponsive to treatment options especially with old age and presence of multiple medical co-morbidties can be offered long term catheterisation as an option to improve the quality of life. The catherisation in such cases can be urethral with a narrow catheter attached to small leg bag that can be worn under cloth or suprabubic as this does not irritate the urethra or trigone, and the urethra cannot be traumatised by the woman pulling on her catheter. The use of long term catheterisation can be a potential risk of recurrent urinary tract infection and clinician can prescribe long term low dose antibiotic prophylaxis [20, 22].

The role of the urogynaecology nurse in those cases is to ensure regular catheterisation care for example changing the catheter and adjust the size to ensure the right fit without urine leakage from around the catheter and look for any elements of skin care required in the perineal area from potential continuous leakage and irritation.
