title: Prospective evaluation of sacral nerve modulation in children with validated questionnaires.
abstract: OBJECTIVE
  Sacral neuromodulation for refractory urinary dysfunction in pediatrics shows promising results. We prospectively evaluated patients undergoing sacral neuromodulation using validated quality of life and bladder dysfunction questionnaires.
  
  
  METHODS
  All patients were prospectively enrolled in the study. Two validated questionnaires were completed preoperatively, after lead placement and at all followups. The PedsQL™ 4.0 Generic Core Scale, which assesses quality of life and bladder dysfunction, was quantified using the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome (NLUTD/DES) questionnaire. The Wilcoxon matched pairs test was used for statistical analysis with p <0.05 considered significant.
  
  
  RESULTS
  A total of 14 patients with a median age of 10 years were enrolled in the study. Median followup was 6 months. All patients underwent generator placement. No significant difference was seen in physical quality of life. Before and after lead placement mean ± SD psychosocial quality of life scores were 70.6 ± 17.4 and 81.43 ± 14.8 (p = 0.02), mean total quality of life scores were 75 ± 15.3 and 84.04 ± 13.2 (p = 0.006) and median NLUTD/DES scores were 23 ± 7.8 and 10.5 ± 7.0 (p <0.001), respectively. One month postoperatively a significant difference was seen in total quality of life and NLUTD/DES scores. Two patients required replacement of the temporary lead or generator. There were no infections.
  
  
  CONCLUSIONS
  Patients undergoing sacral neuromodulation had significant improvement in NLUTD/DES scores, and psychosocial and overall total quality of life. Results were durable at 1 month. Continuing to follow these patients in a prospective manner with validated questionnaires will strengthen the current evidence supporting sacral neuromodulation in the pediatric population.
authors: Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee. Electronic address: heidi.stephany@gmail.com.
authors: Heidi A
authors: HA
authors: Stephany
authors: Trisha M
authors: TM
authors: Juliano
authors: Douglass B
authors: DB
authors: Clayton
authors: Stacy T
authors: ST
authors: Tanaka
authors: John C
authors: JC
authors: Thomas
authors: Mark C
authors: MC
authors: Adams
authors: John W
authors: JW
authors: Brock
authors: John C
authors: JC
authors: Pope
mesh_terms: D006801:Humans; D008160:Lumbosacral Plexus; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014555:Urination Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D014563:Urodynamics / Q000502:physiology*
keywords: DES; NLUTD; QOL; afferent; dysfunctional elimination syndrome; electric stimulation; neurons; nonneurogenic lower urinary tract dysfunction; prostheses and implants; quality of life; urinary bladder