Sacral Neuromodulation
The brain and nerve structures connected to the human body are unbelievably complex. On one hand, this complexity allows us to perform incredible activities, however, on the other, when something is not in balance, the effects can be dramatic.
In the fight against incontinence, we have more tools than ever before. Further, these tools are extremely effective and, in many cases, minimally invasive. When discussing male urinary incontinence, we often see our patients experiencing urge incontinence. This is a form of incontinence whereby the patient experiences a sudden and uncontrollable urge to urinate. Typically, it is followed by leakage of urine.
The bladder holds about 1 cup of liquid before sending signals to urinate. The bladder can hold about 2 cups in total. Normally, patients can control when they urinate, but bladder muscles may spasm or contract inappropriately during urge incontinence due to misfiring neural symptoms.
The symptoms and impediments caused by urge incontinence go far beyond the physical. Many men and women with urge incontinence change their lifestyle so they don’t find themselves in a circumstance where they may be embarrassed in public. Or they will only go to places and functions where a bathroom is readily available.
What Is Axonics Sacral Neuromodulation?
The Axonics sacral neuromodulation device is a small implant that generates low-level electrical signals to stimulate the nerves that control the bladder, thus regulating contraction. The signals the device creates are not painful; patients will not feel significant discomfort after the initial implant. The implant will begin working immediately and help patients control their urinary output and urgency.
The sacral neuromodulation device comes in two forms, one with a fixed non-rechargeable battery lasting approximately 10-20 years and another rechargeable, needing a new charge every 6 to 10 months. Typically, patients have their pick based on preference.
Most side effects of the sacral neuromodulation device are local and transitory, resulting from the implantation of the device. Some patients will feel slight sensations, usually in the foot, due to the electrical impulses generated by the device.
A Game Changer
Sacral neuromodulation offers a significant benefit to the patient. First, the neurostimulator can be tested in the office in just 30 minutes to ensure that it will offer appropriate relief. Should the test go well, it will be permanently implanted by Dr. Tobon in the OR. Even if the stimulator in-office test fails, advanced testing with better lead placement most often leads to success. Neuromodulation also represents a permanent fix for most patients. This means not having to return to the office regularly to adjust or replace the device.
A Note on Tibial Nerve Stimulation
Also worth mentioning is tibial nerve stimulation. Some offices offer this as an external device to patients. By stimulating a nerve in a leg, the impulse will travel up to the spinal cord and indirectly affect the nerves to the bladder. While convenient, the results are not nearly as good as the Axonics sacral neuromodulation device.
Comparing Sacral Neuromodulation to Botox Injections
Sacral neuromodulation is a one-for-one alternative to Botox injections and represents a significant step up for some patients who want a one-and-done solution. The decision-making process depends on patient preference, convenience, and what works. However, BOTOX has some side effects, especially urinary retention, that may require self-catheterization in up to 10% of patients, especially early on. Botox must also be repeated approximately once every six months. On the other hand, sacral neuromodulation is a one-and-done implant that can be tested for efficacy in the office. However, there is the possibility of revision or removal affecting about 3% of patients on average.
A consultation with a qualified urologic surgical practice like ours is the best way to understand your options and which urinary incontinence options are best for you.
