Urinary incontinence is embarrassing and seldom discussed, yet according to the National Association for Continence, about 17 million people in the United States experience bladder control issues. Included in those statistics are 17 percent of women over 18 years of age and one in five adults over age 40, who have overactive bladder or recurring symptoms of urgency and frequency.
Happily, modern advances in technology have made it possible to treat urinary retention and symptoms of an overactive bladder that lead to incontinence by surgically implanting a nerve stimulation system that delivers electrical pulses to electrodes near the sacral nerve located just above the tail bone. This sacral nerve activates and inhibits muscles and smaller nerves that contribute to urinary and bowel control, and also provides signal to the brain about these organs.
“This procedure has been around for more than a decade,” explained Dr. Hugo Davila, a urologist with Florida Healthcare Specialists in Sebastian and Florida Cancer Specialists in Vero Beach. “But just last year a new device, Axonics Sacral Neuromodulation System (SNS), was approved by the FDA and it has been a game-changer in controlling incontinence. This device is like a pacemaker for bladders and once it’s implanted it can last up to 15 years before it needs to be removed.
“The patient can recharge the battery once a month or so with a charging device. Unlike its predecessor, the Axonics device is MRI friendly and doesn’t not need to be removed for that procedure. Ninety percent of patients with the system experience at least a 50 percent improvement in the frequency of urination. That can dramatically affect their quality of life.”
Dr. Davila stresses the importance of open communication with your physician. While the majority of his patients are women over the age of 60, men can also experience bladder issues and may be candidates for the Axonics Sacral Neuromodulation System.
Many patients don’t need the system and will find that treatments such as medication, behavior modification, diet changes and pelvic floor exercise can control their symptoms. If those don’t work, Botox injections into the bladder have been proven effective, but the downside is that those injections need to be repeated every six to nine months.
If conventional treatments prove ineffective, patients can consult their doctor about the two-step SNS procedure. The first stage is a testing stage to see if the therapy will work. With the patient lying face down, the doctor inserts a lead and positions it near the sacral nerve. A female patient is then asked if she feels a tingling sensation in her pelvic muscles or a sensation in the vaginal area. The lead is attached to a wire that exits through a small incision on the lower back or upper buttock. This wire is connected to the external test-phase stimulator that the patient will wear for the next week and control with a hand-held remote. The initial process only takes about 10 minutes and patients go home with all the necessary instructions within an hour or so.
The patient will then keep a detailed bladder/bowel diary to track symptoms. If the device produces the desired results, the patients comes back a week later for the second state implantation. Under sedation, an incision about 2 inches long is made right above the buttocks. The neurostimulator is implanted and directly attached to the wire placed during Stage 1. At that point, the entire system will be under her skin and the patient can communicate with it through a tiny hand-held device. The implant surgery also only takes about 10 minutes and recovery is swift. “I find that most of my patients recover in two to four weeks,” continued Dr. Davila. “It all depends on their level of activity.”
Davila works very closely with the Axonics SNM regional representative, Jason Meyers, who partners with him every step of the way. “Jason is present during the consultation, in the operating room during the procedures, and available to my patients to answer any technical questions about programing. He will instruct the patient on how to manipulate the programs to achieve the maximum results.
“With four levels of programing it may take the patient a few days to figure out which level provides the best benefit of decreased frequency of urination. My patients get to know him and rely on him for programming and technical issues. Our relationship gives our patients maximum access and support for all their needs.”
One satisfied patient, who asked to remain anonymous, said that the SNM procedure changed her life entirely.
“Two years ago, I was running to the bathroom all day and all night long,” she said. “Not only was this terribly embarrassing, but it was expensive, as I was going through about a dozen Depends a day. I restricted my activities and social engagements because I didn’t want to have an accident.
“After trying diet modification, medicine and even Botox treatments to my bladder, Dr. Davila suggested the Sacral Neuromodulation System. My husband and I were shown a film and after consulting with Dr. Davila and Jason, I decided to give it a try. It was my 80th birthday present to myself and the best one ever. I can once again live the life I want. The support team between Dr. Davila and Jason is phenomenal. I credit them with giving back my quality of life.”
Dr. Davila provides a wide range of urological services and treatments including laser, percutaneous and shock wave lithotripsy for kidney stones. He has a special interest in robotic surgery in kidney cancer and female reconstructive surgery, and has treated hundreds of cases with minimally invasive procedures using robotic and laparoscopic techniques. He practices at 8005 Bay Street, #5 in Sebastian, 772-581-0528; and 3730 7th Terrace, #101 in Vero Beach, 772-567-2332.