title: Sacral nerve stimulator revision due to somatic growth.
abstract: OBJECTIVE
  Sacral nerve modulation is a Food and Drug Administration approved treatment for refractory urgency, frequency, urge incontinence and nonobstructive urinary retention in adults. The sparse literature on sacral nerve modulation in children focuses on its initial efficacy in patients with neurogenic bladder and dysfunctional elimination. We describe our initial experience with sacral nerve modulation and the phenomenon of growth spurts associated with lead malfunction that necessitates revision.
  
  
  METHODS
  After receiving institutional review board approval we retrospectively reviewed the charts of pediatric patients who underwent sacral nerve modulation surgery at our institution. Charts were examined for patient demographics, subjective success, the need for further surgery and success after revision.
  
  
  RESULTS
  Four patients underwent sacral nerve modulation at an average age of 12.1 years. All patients reported initial success, defined as greater than 50% symptom improvement. Subsequently 3 patients required a total of 5 revisions due to lead malfunction with an average of 1.5 years between surgeries. In those requiring revision the average somatic growth between revisions was 8.1 cm. Return of efficacy was reported after each revision. All patients had functioning nerve stimulators in place and continued to have a positive subjective response.
  
  
  CONCLUSIONS
  The sparse data on sacral nerve modulation in children shows efficacy and safety similar to those in adults. Somatic growth may be associated with lead malfunction and require surgical revision. We report a small series showing that revision can be done successfully and safely. Informed consent for sacral nerve modulation in pediatric patients should include a discussion of somatic growth as a possible cause of lead malfunction necessitating revision.
authors.affiliation: Children's Hospital Medical Center of Akron, Akron, Ohio, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Clark
authors.forename: Tin
authors.initials: T
authors.lastname: Ngo
authors.forename: Craig V
authors.initials: CV
authors.lastname: Comiter
authors.forename: Rodney
authors.initials: R
authors.lastname: Anderson
authors.forename: William
authors.initials: W
authors.lastname: Kennedy
mesh_terms: D000293:Adolescent; D041923:Adolescent Development / Q000502:physiology*; D002648:Child; D002657:Child Development / Q000502:physiology*; D020878:Device Removal / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008160:Lumbosacral Plexus; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D014554:Urination; D014555:Urination Disorders / Q000503:physiopathology / Q000628:therapy*