Sacral neuromodulation with an implantable pulse generator in children with lower urinary tract symptoms: 15-year experience.
OBJECTIVE
Sacral nerve modulation with an implantable pulse generator is not an established treatment in children. This therapy has been described for dysfunctional elimination syndrome and neurogenic bladder. We report 2 new indications for this approach in children, ie bladder overactivity and Fowler syndrome. The aim of this study was to improve the results of future treatment for sacral neuromodulation in children by describing factors favorable for good outcomes with this method.


METHODS
A total of 18 children 9 to 17 years old were studied. Mean ± SD followup was 28.8 ± 43.8 months. Of the patients 16 underwent S3 sacral neuromodulation and 7 underwent pudendal stimulation (5 as a revision, 2 from the beginning).


RESULTS
Initial full response was achieved in 9 of 18 patients (50%) and partial response in 5 (28%). In patients presenting with incontinence mean ± SD number of incontinence episodes weekly improved significantly from 23.2 ± 12.4 to 1.3 ± 2.63 (p <0.05). In patients requiring clean intermittent catheterization there was a significant decrease in mean ± SD daily frequency of catheterization from 5.2 ± 1.6 to 2.0 ± 1.9 (p <0.05). At the end of the study 6 of 15 patients (40%) had a full response and 5 (33%) had a partial response, while 4 implantable pulse generator devices (27%) were explanted because of failure.


CONCLUSIONS
Sacral neuromodulation is feasible in the pediatric population, with good short-term (78% full or partial response) and satisfactory long-term results (73%). Sacral neuromodulation can offer good results for overactive bladder, dysfunctional elimination syndrome and Fowler syndrome. Pudendal nerve stimulation is a feasible salvage treatment that can be useful in cases when S3 implantation is impossible or unsuccessful.
Pediatric Urologic Nephrologic Center, Ghent University Hospital, Ghent, Belgium. LuitzenAlbert.Groen@uzgent.be
Luitzen-Albert
LA
Groen
Piet
P
Hoebeke
Nele
N
Loret
Charles
C
Van Praet
Erik
E
Van Laecke
Raes
R
Ann
Johan
J
Vande Walle
Karel
K
Everaert
D000293:Adolescent; D002648:Child; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000628:therapy*; D008160:Lumbosacral Plexus; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000628:therapy*