title: Sacral Nerve Stimulation for Pediatric Lower Urinary Tract Dysfunction: Development of a Standardized Pathway with Objective Urodynamic Outcomes.
abstract: OBJECTIVE
  We propose that sacral nerve stimulation is a valid adjunctive therapy for refractory pediatric lower urinary tract dysfunction, and that prospective collection of preoperative and postoperative validated questionnaires and urodynamic data in a standardized fashion is beneficial in characterizing patient response.
  
  
  METHODS
  Patients were candidates for sacral nerve stimulation if they had refractory voiding dysfunction and standard treatments had failed. Preoperative evaluation included urodynamic studies, spinal magnetic resonance imaging, and validated bladder and bowel related questionnaires. Children were stratified into 2 groups, ie overactive bladder with or without incontinence (group 1) and detrusor underactivity/urinary retention requiring clean intermittent catheterization (group 2). A staged procedure was used with initial test lead placement, followed by permanent device insertion 2 weeks later if patients demonstrated symptom improvement with test lead. Postoperatively children were followed with questionnaires and at least 1 urodynamic study.
  
  
  RESULTS
  A total of 26 children underwent sacral nerve stimulation. Mean patient age was 10.8 years and median followup was 1.2 years. There were 23 patients in group 1 and 4 in group 2 (1 patient was included in both groups). In group 1 voiding dysfunction scores improved significantly, and urodynamic studies revealed a significant decrease in mean number of uninhibited contractions and maximum detrusor pressure during the filling phase. In group 2 there was significant improvement in mean post-void residual.
  
  
  CONCLUSIONS
  Sacral nerve stimulation is a treatment option that may produce significant improvement in objective and subjective measures of bladder function in children with refractory lower urinary tract dysfunction.
authors.affiliation: Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Schober
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sulkowski
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lu
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Surgical Outcomes Research, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio; Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Teich
authors.affiliation: Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio; Department of Urology, Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: seth.alpert@nationwidechildrens.org.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Alpert
mesh_terms: D002648:Child; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000503:physiopathology* / Q000628:therapy*; D008160:Lumbosacral Plexus / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000628:therapy; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy; D016055:Urinary Retention / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics / Q000502:physiology*
keywords: electric stimulation therapy; electrodes; implanted; overactive; pediatrics; urinary bladder; urinary incontinence