title: Sacral neuromodulation in children with urinary and fecal incontinence: a multicenter, open label, randomized, crossover study.
abstract: OBJECTIVE
  The clinical benefit of sacral neuromodulation is unclear due to the paucity of randomized trial data. The purpose of this study was to evaluate sacral neuromodulation for management of urinary and fecal incontinence in a pediatric population.
  
  
  METHODS
  This multicenter, open label, randomized, crossover study included children older than 5 years. After trial stimulation of the S3 root a neuromodulator (InterStim) was implanted on the S3 foramen. Clinical examinations, voiding and bowel diaries, and urodynamic and manometric evaluations were performed at the beginning (t1) and end (t2) of the first period, and at the beginning (t3) and end (t4) of the second period.
  
  
  RESULTS
  A total of 33 patients (24 boys) with a mean +/- SD age of 12.22 +/- 5.09 years were randomized. Etiologies were mainly of neurological origin. Incontinence was mixed urinary and fecal in 19 cases, urinary only in 9 and fecal only in 5. Cystometric bladder capacity increased during sacral neuromodulation (delta +24.27 ml vs -37.45 ml, p = 0.01). There was no significant change in other urodynamic or manometric parameters. Overall positive response rate was more than 75% for urinary (81%) and bowel (78%) function. Crossover analysis indicated that sacral neuromodulation is more effective than conservative treatment for both types of incontinence (p = 0.001).
  
  
  CONCLUSIONS
  In a pediatric population sacral neuromodulation is effective for bladder and bowel dysfunction and should be considered before irreversible surgery.
authors.affiliation: Department of Pediatric Surgery, Hôpital d'Enfants de la Timone, Marseille, France. mirna.haddad@ap-hm.fr
authors.forename: M
authors.initials: M
authors.lastname: Haddad
authors.forename: R
authors.initials: R
authors.lastname: Besson
authors.forename: D
authors.initials: D
authors.lastname: Aubert
authors.forename: P
authors.initials: P
authors.lastname: Ravasse
authors.forename: J
authors.initials: J
authors.lastname: Lemelle
authors.forename: A
authors.initials: A
authors.lastname: El Ghoneimi
authors.forename: J
authors.initials: J
authors.lastname: Moscovici
authors.forename: F
authors.initials: F
authors.lastname: Hameury
authors.forename: K
authors.initials: K
authors.lastname: Baumstarck-Barrau
authors.forename: G
authors.initials: G
authors.lastname: Hery
authors.forename: J M
authors.initials: JM
authors.lastname: Guys
mesh_terms: D002648:Child; D018592:Cross-Over Studies; D004599:Electric Stimulation Therapy; D005242:Fecal Incontinence / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D011446:Prospective Studies; D014549:Urinary Incontinence / Q000628:therapy*