Medtronic announced on September 19, 2025, that the FDA has approved its Altaviva implantable tibial neuromodulation device for treating urge urinary incontinence, representing what the company describes as "a first among implantable tibial devices" that allows patients to return home with therapy already activated. The approval addresses a significant unmet medical need affecting an estimated 16 million Americans who experience sudden urges followed by involuntary bladder leakage.
Device Design and Clinical Advantages
The Altaviva device, approximately half the length of a stick of chewing gum, is implanted near the ankle during a minimally invasive procedure that requires no sedation or imaging guidance. The device sits below the skin and above the fascia, delivering electrical impulses to the tibial nerve to help restore communication between the bladder and brain.
"The Altaviva device represents a significant advancement for patients with urge urinary incontinence who often weigh the invasiveness of a therapy and the potential side effects when considering treatment options," said Kevin Benson, MD, a urogynecologist at Sanford Health and investigator for the Altaviva device pivotal study. "I'm excited to offer my patients this simple experience and believe the Altaviva device has the potential to transform lives and bring new hope to more people."
The device features a 15-year battery lifespan under normal settings and requires only occasional 30-minute recharging sessions using the default recharging speed. Additionally, the device maintains MRI compatibility, addressing a common concern with implantable medical devices.
Clinical Trial Evidence
The FDA approval was supported by data from the pivotal TITAN 2 trial (NCT05226286), which enrolled 188 adult patients with urge urinary incontinence across 29 clinical trial sites in the United States. Study participants were required to have a diagnosis of urge urinary incontinence for at least 6 months and to have failed or been unsuitable candidates for conservative therapies.
The primary outcome measure evaluated the proportion of patients experiencing at least a 50% reduction in urge urinary incontinence episodes at 6 months following device implantation. Secondary endpoints included changes in urinary frequency episodes per day, urinary urgency based on the urgency perception scale, and quality of life scores using the overactive bladder quality of life questionnaire health-related quality of life (OAB-q-HRQL) total score at 6 months.
Safety Profile and Feasibility Data
The TITAN 2 study followed positive findings from the earlier TITAN 1 feasibility study (NCT04873271), which successfully implanted the device in 20 patients. All patients in the feasibility study demonstrated motor and/or sensory response to stimulation both during and after the procedure, as well as at the 7-day follow-up visit. At the 14-day follow-up, 18 of 19 assessed patients maintained motor and/or sensory response.
The safety profile from the feasibility study showed 5 device-, procedure-, and/or therapy-related adverse events across 3 patients, including 1 serious adverse event involving wound infection that led to device explantation at 6 weeks following implant.
Market Impact and Clinical Significance
Bladder control issues affect an estimated 43 million Americans, yet only about one in four people with bladder control problems have discussed symptoms with a healthcare provider. The condition often leads patients to rely on diapers or pads, significantly impacting quality of life.
"Too many people silently struggle with the challenges of urgency and loss of bladder control, often believing that relying on diapers or pads is their only option," said Brett Wall, executive vice president and president of the Medtronic Neuroscience Portfolio. "The Altaviva device represents a transformative milestone and ushers in a new bladder control therapy with advanced features."
With the Altaviva approval, Medtronic becomes the only company offering a comprehensive suite of neuromodulation therapies for bladder control, positioning the company as what it describes as "the global leader in neuromodulation" in this therapeutic area.
