Nerve zapper that ends indignity of those little leaks
ABATTERY- p o wered pacemaker implanted in the buttock could banish embarrassing leaks for millions o f p e o p l e wi t h bladder-control problems.
The implant, about the size of a USB memory stick, works by zapping a nerve in the spine that helps to control urine flow.
An added bonus of the device, made by US firm Axonics, is that it is the first that can be recharged wirelessly through the skin. It lasts 15 years – three times as long as existing implants currently offered on the NHS.
British experts say t he new implant, which costs £20,000 privately, could slash the number of surgical procedures patients need.
Neil Harris, consultant urological surgeon at Leeds Teaching Hospitals NHS Trust and Spire Leeds Hospital, says: ‘Previous systems were about the size of a matchbox, but this is far smaller, which means we need to make only a tiny incision of less than half an inch. And it’s rechargeable, so it should save patients repeated surgery.’
Overactive bladder affects about eight million men and women in the UK and triggers a sudden need to urinate, day or night.
It is caused by a problem with the detrusor muscles, located in the walls of the bladder. These relax to allow the bladder to fill with urine, then contract to let it out when it is full. But sometimes the muscles contract too often, creating a sudden and urgent need to go. A good long-term solution to overactive bladder, available on the NHS, has been sacral nerve modulation, where a tiny generator is implanted in the lower back and wired up to the sacral nerve, which runs from the spine to the pelvis and controls the bladder.
But existing stimulators need to be swapped for new ones after just five years, once the batteries die.
The Axonics implant lasts three times as long because it has a rechargeable battery. This is topped up once every two weeks, using a special belt with a built-in charger, positioned to sit directly over the implant The patient just pops the belt on for an hour. A major international study found that 91 per cent of patients saw a significant improvement in symptoms and quality of life after having the Axonics implant.
Although it was approved for sale in the UK in 2016, until recently it was available only as part of a clinical trial.
Amy Lyons, 22, from Leeds, was one of the first people in Britain to benefit. After recovering from a kidney infection, she found she no longer had any control over her bladder.
‘I’d leak unexpectedly, so I needed to carry three changes of under- wear and was scared to go out,’ she says. ‘I developed agoraphobia and had to quit my studies.’
Amy was referred to Spire Leeds Hospital and her consultant suggested the new long-lasting implant. Last April, she had a 60-minute procedure under a spinal anaesthetic.
During this, the surgeon makes a 1cm incision in the lower back and uses X-ray images to guide a 5mm- diameter cannula ( hollow tube) into the sacrum at the bottom the spine. A 30cm-long wire, 3mm in diameter, is then fed through the cannula and four electrodes stimulate the sacral nerve to ensure the wire is in the right place.
With the lead fixed in place, a second small incision is made above the buttock to implant the generator just beneath the skin. Finally, the wire is tunnelled under the skin to connect it to the generator.
Amy says: ‘ I left hospital just three hours after surgery, and could pee naturally that evening – it was wonderful. I feel I’ve got far more control over my bladder. Now I’d like to go back to university and fulfil my dream of becoming a speech and language therapist.’
More than 50 hospitals offer sacral nerve modulation within the NHS, including University College of London Hospital, Leeds Teaching Hospitals and University Hospital of Southampton.
The Axonics i mplant will be rolled out to NHS trusts through 2019. It i s currently available at University College of London Hospital and University Hospital of Southampton.
Mr Harris says: ‘ I am very impressed, and patients so far have been very pleased.’