Altaviva™ Implantable Tibial Nerve Stimulation for Urge Urinary Incontinence

The Science

The posterior tibial nerve originates from the same spinal segments (S2-S4) that control bladder function. Stimulating this nerve at the ankle sends signals back to the sacral nerve plexus and brainstem, modulating the overactive bladder reflexes that cause urgency and leakage.

• Reduces involuntary bladder contractions that cause urgency.
• Restores normal nerve communication between bladder and brain.
• Improves bladder capacity and decreases voiding frequency.
• Delivers therapy automatically — no manual activation needed.

Device Features

• Size: Approximately half the length of a stick of gum; sits below the skin above the fascia near the ankle.
• Battery Life: Expected 15 years with Medtronic's proprietary Overdrive™ battery technology.
• Recharging: Only 1-2 times per year under standard settings (~30 minutes per session).
• MRI Compatibility: Full-body MRI-ready from day one (1.5T and 3T).
• Therapy Activation: Same-day activation after implant; automatic delivery.
• Implant Location: Near the ankle, placed through a 2 cm incision along Langer lines.

Before the Procedure

• Complete bladder symptom questionnaires (OAB-q, ICIQ) and voiding diary.
• Review current medications with your physician — blood thinners may need to be paused.
• No shaving near or on the ankle 48 hours before the procedure.
• No fasting or pre-operative clearance required.
• Procedure is scheduled in the office — no hospital visit needed.

During the Procedure

• In-office procedure — no sedation or imaging required.
• Local anesthesia is applied to numb the area near the ankle.
• A small 2 cm incision is made along natural skin lines (Langer lines) near the medial ankle.
• Altaviva device is placed above the fascia adjacent to the posterior tibial nerve.
• Incision closed with sutures; device is not visible externally.
• Therapy is activated the same day — the device begins working immediately.

Immediate Recovery

• Walk out of the office after the procedure — no recovery room needed.
• Mild soreness or tenderness at the implant site for a few days (over-the-counter pain relief as needed).
• Keep the incision clean and dry for 48 hours, then normal showering is fine.
• Avoid heavy lifting or vigorous exercise for approximately 1 week.
• Most patients return to work and normal activities the next day.

Symptom Improvement Timeline

• Day 1: Therapy begins automatically after same-day activation.
• Weeks 2-6: Many patients begin noticing reduced urgency and fewer leakage episodes.
• 3 months: Significant improvement typically seen; assessed with questionnaires and voiding diary.
• 6-12 months: Continued benefit with ongoing automatic therapy delivery.
• Follow-up visits scheduled to monitor progress and optimize as needed.

Common Side Effects

• Mild pain or tenderness at the implant site (typically resolves within a few days to a week).
• Temporary swelling or bruising near the incision.
• Mild tingling sensation near the ankle (adjustable with device programming).

Less Common Complications

• Implant-related infection (~4% in TITAN trial; treated with antibiotics or device removal if needed).
• Implant site pain persisting beyond initial recovery (~3% in TITAN 2 trial).
• Device migration or repositioning (rare; may require a minor revision procedure).

Will I feel the device under my skin?

Altaviva is very small and sits flat above the fascia near the ankle. Most patients forget it's there after the incision heals. It does not interfere with walking, wearing shoes, or normal activities.

How is Altaviva different from eCoin?

Both are implantable tibial nerve stimulators placed near the ankle. Altaviva offers a much longer battery life (15 years vs. ~3 years), MRI compatibility from day one, rechargeable technology (1-2 charges per year), and is backed by Medtronic's extensive neuromodulation platform. eCoin is non-rechargeable and requires full device replacement after approximately 3 years.

Can I get an MRI with Altaviva?

Yes. Altaviva is MRI-ready from the day of implantation and compatible with both 1.5T and 3T full-body MRI scans. Always carry your device ID card and inform the MRI technologist.

How long does the procedure take?

The implantation takes approximately 15-20 minutes and is performed in the office under local anesthesia. No sedation, imaging, or hospital visit is required. Therapy is activated the same day.

How often do I need to recharge?

Under standard settings, recharging is needed only 1-2 times per year. Each session takes about 30 minutes using a small external charger placed over the ankle area. The battery is expected to last up to 15 years.

What if Altaviva doesn't work for me?

If you don't achieve adequate symptom relief, the device can be removed with a simple procedure. We then discuss alternative treatments such as InterStim, Botox injections, or other options tailored to your needs.

Is Altaviva covered by insurance?

Coverage varies by plan. As a newly FDA-approved Medtronic device, insurance coverage is being established. Our team will verify your coverage and obtain prior authorization before scheduling your procedure.

Can I exercise and swim with Altaviva?

Yes. After the initial 1-week healing period, you can resume all normal activities including exercise, swimming, and sports. The device is implanted under the skin and designed for an active lifestyle.