Ease drug-resistant overactive bladder with wireless device, doctors advised

Author: Caroline White

An overactive bladder can be treated with a rechargeable wireless device fitted under the skin, the National Institute for Health and Care Excellence (NICE) has said in new draft guidance issued today.

The option is recommended for those who haven’t responded to other forms of treatment for the condition.

Nearly one in five people in the UK are estimated to have an overactive bladder, the symptoms of which include the need to pass urine frequently with or without an uncontrollable urge.

Women and the elderly are those most likely to be affected. Leakage of urine associated with the strong desire to go to the toilet may also be a problem.

Inserted under the skin in the upper buttock, the Axonics sacral neuromodulation (SNM) simulates the sacral nerve with an electric current via an electrode. The electrode is attached to an implantable pulse generator which stimulates the nerves associated with bladder function.

The aim is to make the bladder work in a more controlled way, rather like a pacemaker for the heart.

A handheld remote control operated by the patient activates the stimulator. This also adjusts the stimulation amplitude and checks the battery status.

A wireless charger, attachable to the skin over the implanted stimulator is used to charge the stimulator. The company claims that the battery needs a recharge only every 1-2 weeks for 30 to 60 minutes.

The implanted device is programmed by a clinician in an outpatient clinic using a portable tablet.

The Axonics device would be an option for people with symptoms of overactive bladder who have not responded to conservative or drug treatments, in line with previously published guidelines NG123 and CG97, says NICE.

Each Axonics device costs £9,660. Based on current data it is thought the battery will last for around six years before it needs replacing although there is some evidence to suggest it could last as long as 15 years.

Cost modelling by NICE suggests that six years is the point at which the device saves money compared with the current non-rechargeable system. Axonics SNS could therefore save the NHS around £6,200 per patient, assuming a 15-year life span.

Meindert Boysen, director of the centre for health technology evaluation at NICE, said: “Clinical trial evidence seen by our independent committee shows that Axonics can help improve quality of life for people with symptoms caused by an overactive bladder.

“This device will last longer than the current non-rechargeable system, resulting in a cost saving for the NHS after six years of use, and, importantly for patients, fewer replacement surgeries.”

Health minister Nicola Blackwood added: “This revolutionary device offers a new solution to help people managing this condition to go about their everyday lives free from worry or disruption.

“Our priority is to ensure NHS patients have access to the latest innovative treatments and today’s announcement is further proof that the UK continues to be the world-leading destination for revolutionary healthcare.”

The guidance is now out for consultation until Friday 13 March 2020.