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eCoin® — Implantable Tibial Nerve Stimulator

eCoin (Valencia Technologies, acquired by Axonics / now Boston Scientific) is a self-contained, nickel-sized implantable tibial nerve stimulator — the first FDA-approved ITNS (Implantable Tibial Nerve Stimulation) device, cleared in March 2022 for refractory urgency urinary incontinence.

Design​

  • Shape and size of a nickel (~23 mm diameter, very thin profile)
  • Single-unit device — lead, electronics, and battery all integrated into the coin-shaped shell
  • No external components, no leads, no separate pulse generator
  • Pre-programmed automated stimulation schedule — no daily patient action required
  • Battery life ~3–4 years; device is replaced or discontinued after depletion

Implantation​

  • Office or outpatient procedure under local anesthetic
  • Small incision (1–2 cm) near the medial ankle, above the medial malleolus
  • Device placed subcutaneously adjacent to the posterior tibial nerve
  • Wound closed with absorbable suture; bandage; no postop limitations beyond initial wound care

How It Works​

After a healing period, the device delivers automated pre-programmed stimulation sessions (typically 30 minutes per session, 1–2 sessions per week for the first 18 weeks; then every 2 weeks as maintenance). Patient does nothing daily — the device operates on its internal schedule.

Clinical Efficacy​

  • ~70% responder rate (≥50% reduction in UUI episodes)
  • ~20–25% dry rate (no UUI episodes)
  • Durable through 24 months in pivotal trial follow-up

Advantages​

  • Minimally invasive office implantation
  • No recharging — battery lasts through the intended device life
  • Automated therapy — no patient compliance burden beyond battery replacement
  • Reversible — device can be explanted

Limitations​

  • Battery life requires eventual replacement
  • Limited patient control — stimulation parameters fixed by manufacturer; cannot be adjusted for patient-specific response
  • Single-indication approval — UUI only at present (not retention, not fecal)

Positioning​

eCoin pioneered ITNS as a class. Revi and Altaviva followed with different engineering approaches (external-power wearable, simpler surgical placement).

See also: Revi System, Altaviva, PTNS Systems, Medtronic InterStim.