Axonics Therapy:

The Permanent and Effective OAB Solution

Dr. Joseph Pazona, Board Certified Urologist

Are you frustrated with your overactive bladder (OAB)? Do you spend more time in the bathroom than any other room in your house? When you “have to go” are you knocking people down on the way to the bathroom like you’re Alabama’s running back?

I’m sure you’ve tried the infamous “bladder-friendly diet” where you can’t eat or drink anything but water and cardboard. The overactive bladder medications make your mouth so dry that you’re drinking more fluids than ever, which leads to . . . going to the bathroom all day! Ugh!

If this sounds all too familiar, then despair no longer. Your solution is Axonics Therapy.

What is Axonics Therapy?

Axonics sacral neuromodulation is an implantable medical device that delivers painless stimulation to the nerves controlling your bladder and bowels. It is placed in the upper buttocks area through a minimally invasive procedure. There is a lead (wire) that stimulates the S3 (3rd sacral) nerve route via communication with a neurostimulator or battery.

How does Axonics Therapy work?

For patients suffering with an overactive bladder, there is something wrong with the communication pathway between the bladder and brain. Normally, as the bladder fills, it sends a signal via the pelvic nerves and spinal cord to the brain. The brain then says, “hey, you should go to the bathroom because your bladder is full.”

In overactive bladders, the signal is sent to the brain with little to no warning. Therefore, patients notice urinary frequency, urgency and even bladder leakage.

Axonics therapy modulates or “rewires” this faulty nerve pathway so the bladder and brain can once again be on the same team.

Who is a candidate for Axonics Therapy?

The most common indication for Axonics Therapy is in the treatment of an overactive bladder. OAB symptoms may include:

  • Urinary frequency (< every 2 hours)
  • Strong urges to urinate
  • Excessive urination at night time
  • Urge urinary incontinence (bladder leakage with little to no warning)

Axonics therapy is also >90% effective for the treatment of fecal incontinence (involuntary loss of stool) when other therapies have failed.

Finally, Axonics therapy can also help some patients (usually women) who cannot empty their bladder even though there is no obvious anatomic blockage or obstruction.

How do I know if I’m a candidate for Axonics Therapy?

Axonics therapy may be right for you if you suffer from overactive bladder (OAB) symptoms and have failed the following therapies:

  • Bladder-friendly diet (limit caffeine, alcohol, acidic foods/drinks)
  • Stool softeners (constipation can cause OAB symptoms)
  • 2 or more overactive bladder medications

The best way to find out if you’re a candidate for Axonics Therapy is to schedule a consultation with a board-certified urologist who specializes in the treatment of female incontinence.

What is the first step of Axonics Therapy?

The first step to make certain that Axonics Therapy will help your OAB symptoms is a percutaneous nerve evaluation (PNE). This painless procedure is usually performed in an office setting under local anesthesia, with or without sedation.

While lying on your back, the doctor will mark out some landmarks on your lower back, overlying the bony sacrum and coccyx (tailbone). After injecting local anesthesia, a small needle will be placed in the opening (foramen) of the 3rd sacral nerve (S3). A tiny electrode or wire is then placed internally and taped to your skin.

The electrode is connected to an external battery stimulator and you’re home in no time. The whole procedure takes 10-15 minutes and has minimal to no risk.

During the trial period of 3-14 days, you will keep a bladder diary to document the following:

  • How often you urinate
  • Degree of urinary urgency (were you still knocking people over running to the bathroom?)
  • Leakage episodes
  • Number of times you awoke at night to urinate

70% of patients return to the office a week later with a huge smile on their face because the Axonics Therapy was a game changer. It’s not unusual for us to exchange hugs and tears of joy. It’s that incredible.

We then remove the temporary wires and schedule a permanent implantation.

What’s involved with the permanent Axonics implant?

This is a minor surgery performed in an operating room. General anesthesia is usually necessary, but the procedure takes only 20 minutes. You’ll have a pretty quick recovery.

This time we use live X-ray pictures to aid in the best placement of a permanent lead (wire) and neurostimulator (battery) in the upper buttock/lower back area.

The Axonics neurostimulator is the size of a computer USB or thumb drive.

Axonics

It is placed through a small incision underneath the skin. Most patients don’t notice the battery.

Once in place, the Axonics implant has a 15-20 year battery life. It comes with a remote control and a velcro recharging belt so we can keep the device working properly. This way you can focus on other things in your life instead of your bladder!

What happens if Axonics Therapy doesn’t work for me?

If the nerve evaluation in the office doesn’t quite live up to expectations, we can perform a stage 1 trial in the operating room. This involves placing a lead in the operating room similar to the permanent device.

By using a more sophisticated lead with the guide of live X-rays, patients will often respond to Axonics therapy. A second surgery will then be scheduled a week later to either attach the lead to a permanent battery or, if still unsuccessful, the lead will be removed.

What about bladder Botox injections?

For patients who still don’t respond to the stage 1 trial, the only other option is a bladder injection with Botox. No, your bladder doesn’t have Crow’s feet or wrinkles. But it is a muscle that can be partially “paralyzed” by Botox cutting down on frequent bathroom trips.

The downsides to bladder Botox include:

  • Temporary results (need to be repeated every 3 to 6 months)
  • Increased risk of bladder infections
  • 8% risk of being unable to urinate requiring a urinary catheter for up to 2 months

Will I have any limitations with Axonics Therapy?

Great question. Other than notifying airport security that you have a medical device (if we are ever able to fly again 😢) you can live your life again without limitations!

The Axonics implant is also MRI friendly (unlike some other devices) and won’t impact any future medical treatments.

Axonics Therapy sounds wonderful! What are my next steps?

If you’re in the Nashville area or want to road trip to Music City, give us a call at Pazona MD to schedule a consultation.

(615) 527-4700

Also, feel free to email any questions to: hello@pazonamd.com

If Nashville is not close to home for you, then research a urologist or urogynecologist who specializes in the treatment of urinary incontinence and Axonics Therapy.

Axonics Therapy can literally change your life in a wonderful way. Please stop suffering with overactive bladder symptoms and just give us a call. Your bladder will thank you.

Warm regards!

Dr. P

Dr. Joseph Pazona is a board-certified urologist in Nashville TN at Pazona MD. He has expertise in treating all forms of female incontinence and has been performing sacral neuromodulation procedures such as Axonics since 2008.

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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