Nerve zap­per that ends in­dig­nity of those lit­tle leaks

The Mail on Sunday - - Health - By Carol Davis ax­on­ic­smod­u­la­tion.com

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.’

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