Greater Boston Urology Blog

Introducing eCoin for Treating Urinary Incontinence in Women & Men

eCoin is the newest evidence-based treatment for urinary incontinence in women and men. Dr. Angel Marie Johnson, the Director of our Women's Health Centers, was involved in the FDA approval process, and starting in August (2023), she'll be the first doctor in Massachusetts to perform this procedure.

We asked her to answer questions about eCoin, including how it works, who's a good candidate, and next steps if you think eCoin might be the right fit for you.

As with all content on the GBU blog, the following is meant to be educational only, not medical advice. Always consult a physician about your specific healthcare needs.

What is eCoin?

DR. JOHNSON: eCoin is a nickel-sized, battery-powered neurostimulator device used to treat patients who have overactive bladder (OAB) syndrome.

With OAB, patients can experience things like urgency (that "I've got to go NOW" feeling), frequency, and nocturia (endless trips to the bathroom at night).

eCoin was FDA approved in December 2022. I took part in the FDA approval process. The FDA wanted to make sure urogynecologists like me would be comfortable performing this procedure, given it's located in an area of the body that we don't typically work on—the ankle.

How does eCoin work?

DR. JOHNSON: eCoin is similar to a procedure we've been doing for decades on patients with overactive bladder: PTNS or percutaneous tibial nerve stimulation.

With PTNS, I tap a very thin needle—similar to an acupuncture needle—near the medial malleolus (the bony bump on the inner side of the ankle). The needle stimulates the tibial nerve, which causes stimulation of the nerves around the bladder. I activate the needle for 30 minutes, and this stimulation leads to bladder relief.  

The problem with PTNS is that I must perform this treatment in the office, and patients must return regularly for treatment, often for years.

With eCoin, we've essentially taken this external treatment and made it internal. Instead of using an acupuncture needle, we place a nickel-sized device under the skin near that same bone. Every three to four days, the eCoin device turns itself on, activates for 30 minutes, and then goes back to sleep.

Just like PTNS, eCoin stimulates the tibial nerve—but it does so automatically. The result is sustainable bladder improvement that doesn't require weekly or monthly visits to my office.

eCoin offers several other key benefits as well:

  • The battery can last anywhere from three to seven years before it needs to be replaced.
  • eCoin is safe for patients with pacemakers (PTNS is not safe for patients with pacemakers).
  • With eCoin, patients can get an MRI as long as it's above the knee ( 20 centimeters away on average from the device).

What happens during the eCoin procedure?

DR. JOHNSON: The procedure is straightforward and performed under local, not general anesthesia. This is good news for patients, since there's increasing evidence that anesthesia can have temporary or even long-term cognitive effects, such as memory loss or brain fog. It's often hard to predict who's vulnerable, although evidence suggests the elderly or people who already have memory impairment due to conditions like Alzheimer's or Parkinson's disease are particularly vulnerable. So I prefer avoiding general anesthesia if at all possible.

As for the procedure itself, I make a small incision in the skin (about two centimeters), place the device under the skin, and close the incision—that's it.

Who is eligible for eCoin, and where can they get it?

DR. JOHNSON: At GBU, I am the only physician currently offering this treatment. Medicare patients, both men and women with urinary incontinence, can have eCoin placed at Eastern Massachusetts Surgical Center in Norwood.

As for patients eCoin wouldn't be appropriate for . . . as long as the patients with overactive bladder syndrome have healthy ankles—meaning they don't have swelling, they don't have difficulty with wound healing, and they don't have diabetic ulcers—they will likely be a good candidate. Male patients must also have a normal size prostate or be receiving treatment for BPH.

Interested in eCoin to treat your urinary incontinence? Request an appointment.

If you're interested in eCoin, make an appointment with Dr. Angel Marie Johnson to see if eCoin is right for you.

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