The study is a single arm, prospective study of the safety and effectiveness of the Valencia Technologies eCoin System to stimulate the tibial nerve for the treatment of patients with refractory urgency urinary incontinence.

This trial is a single arm, prospective study of the safety and effectiveness of eCoin tibial nerve stimulation in 25 subjects with refractory overactive bladder as defined by the American Urological Association.. The eCoin neuromodulation device will be implanted subcutaneously in the right or left leg of patients with urgency urinary incontinence. After a 4 week implant healing period, subjects will have their devices activated (turned ON). After 3 months of device therapy (occurring 4 months post-implant), the primary endpoint will be assessed. It is anticipated that subjects will reach the full therapeutic effect at approximately 3 months of therapy. Subjects will be followed for an additional 9 months to assess the safety of maintenance stimulation therapy with fewer sessions occurring during this time interval.

Inclusion Criteria:

1. Women and men 18 years and older.
2. Diagnosis of overactive bladder with urgency urinary incontinence or mixed urge and stress incontinence with a predominant urgency component, for at least 6 months (self-reported).
3. Individual has at least four urgency incontinence episodes on a three-day voiding diary with at least one episode per 24 hour time period
4. Individual with urinary frequency, defined as an average of greater than or equal to 8 times/24 hours (ie. a total of greater than or equal to 24 micturitions on a 3 day diary)
5. Individual is unresponsive to, inadequately responsive to, or intolerant of behavioral, rehabilitation, and pharmacologic therapy.
6. Individual is able to give his or her written, informed consent.
7. Individual is mentally competent and able to understand all study requirements.
8. Individual is willing and able to complete a 3-day voiding diary and quality of life questionnaire.
9. Individual is without pharmacological treatment of overactive bladder (antimuscarinics and beta-3 agonists) for 2 weeks prior to screening.
10. The individual demonstrates a positive nerve integrity test.

Exclusion Criteria:

1. Individual has predominantly stress urinary incontinence
2. Individual has clinically significant bladder outlet obstruction.
3. Individual has clinically significant pelvic organ prolapse.
4. Individual has abnormal post void residual (i.e., greater than 150 cc).
5. Individual has clinically significant urethral stricture disease or bladder neck contracture
6. Individual has an active urinary tract infection at time of enrollment.
7. Individual has recurrent urinary tract infections defined as 4 or more UTI's per year.
8. Individual has morbid obesity.
9. Individual has had positive urine cytology or diagnosis of bladder or prostate cancer.
10. Individual has neurogenic bladder dysfunction.
11. Individual is taking an alpha-blocker for benign prostatic hyperplasia.
12. Individual is pregnant or intends to become pregnant during the study.
13. Patient is breast feeding or is less than 9-month post-partum.
14. Individual has the presence of urinary fistula, bladder stone, or interstitial cystitis.
15. Individual has uncontrolled diabetes mellitus.
16. Individual has a cardiac pacemaker or implanted defibrillator.
17. Individual has been previously treated with sacral nerve stimulation.
18. Individual has been treated with onabotulinumtoxinA in the previous 9 months prior to enrollment.
19. Individual has been treated with percutaneous tibial nerve stimulation within the previous 12 weeks prior to enrollment.
20. Individual requires regular Magnetic Resonance Imaging for other health care conditions. (ASK)
21. Individual has a clotting or bleeding disorder; antiplatelet and anticoagulant therapy may be continued or held at the discretion of the investigator
22. Individual has a clinically significant peripheral neuropathy.
23. Individual is neutropenic or immunocompromised.

Baseline analyses includes the baseline information for enrolled and implanted participants. Data on 3 participants were imputed per protocol.

Adverse event data was collected from enrollment through 6 months after implantation.

The safety population consisted of all eligible and enrolled participants. AEs were graded at the study centers as mild, moderate, or sever; serious or not serious; classified as related or unrelated; and classified as causing or not causing study termination. The Data Safety and Monitoring Board reviewed all AEs to confirm relatedness.

This was a small study with a nonrandomized design and no control group. Studies in larger populations may clarify the factors associated with responders. The initial study period was short at only 3 months, and should be investigated further for durability.