title: Sacral neuromodulation for the dysfunctional elimination syndrome: a 10-year single-center experience with 105 consecutive children.
abstract: OBJECTIVE
  To evaluate our initial experience using sacral neuromodulation via implanted pulse generator as a treatment for children with dysfunctional elimination syndrome and symptoms refractory to maximum medical therapy.
  
  
  METHODS
  There were 105 consecutive patients who underwent a 2-stage procedure with a trial period (n = 89) or a single procedure (n = 16) for device implantation. They were followed up prospectively for a median of 2.72 years (average, 3.18 years; range, 0.01-9.63 years) for symptom improvement and resolution.
  
  
  RESULTS
  Nearly all children (99 of 105 [94%]) experienced improvement of at least 1 symptom; 12 of 105 patients (11%) had at least 1 symptom worsen. Urinary incontinence, constipation, frequency and/or urgency, and nocturnal enuresis improved in 89 of 101 (88%), 73 of 92 (79%), 54 of 81 (67%), and 59 of 89 (66%) children, respectively, and resolved in 41 of 101 (41%), 37 of 92 (40%), 23 of 81 (28%), and 25 of 89 (28%) children, respectively. Outcomes among patients who did and did not undergo the trial were not significantly different (P = .19-1.00), and only 2 of 88 patients did not undergo permanent implantation. Reoperations (n = 85) occurred in 59 of 105 children (56%), mainly for device malfunction (n = 42), whereas explantation was performed in 36 of 104 children (35%) at an average of 2.68 years since implantation (median, 2.36 years; range, 0.03-9.04 years), mainly for complete symptom resolution (n = 12). Explantation for any reason was less common after single-stage procedures (1 of 16 [6%] vs 35 of 88 [40%] patients; P = .01).
  
  
  CONCLUSIONS
  Sacral neuromodulation should be considered for children with dysfunctional elimination syndrome whose symptoms are refractory to maximum medical therapy understanding that the risk of reoperation is >50%. Elimination of the trial period reduces the number of general anesthetics without sacrificing outcomes.
authors.affiliation: Department of Urology, Mayo Clinic Rochester, Rochester, MN. Electronic address: urology@moiradwyer.com.
authors.forename: Moira E
authors.initials: ME
authors.lastname: Dwyer
authors.affiliation: Department of Urology, Mayo Clinic Rochester, Rochester, MN; Children's Hospitals and Clinics of Minnesota, Minneapolis, MN; Pediatric Surgical Associates, Minneapolis, MN.
authors.forename: David R
authors.initials: DR
authors.lastname: Vandersteen
authors.affiliation: Children's Hospitals and Clinics of Minnesota, Minneapolis, MN; Pediatric Surgical Associates, Minneapolis, MN.
authors.forename: Pam
authors.initials: P
authors.lastname: Hollatz
authors.affiliation: Department of Urology, Mayo Clinic Rochester, Rochester, MN; Children's Hospitals and Clinics of Minnesota, Minneapolis, MN; Pediatric Surgical Associates, Minneapolis, MN.
authors.forename: Yuri E
authors.initials: YE
authors.lastname: Reinberg
mesh_terms: D000293:Adolescent; D002648:Child; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators; D008160:Lumbosacral Plexus; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D014555:Urination Disorders / Q000628:therapy*