Sacral nerve stimulation therapy for CHILDREN

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Urol. 2008

Jul;180(1):306-11; discussion 311. Epub 2008 May 21.

Sacral neuromodulation for the dysfunctional

elimination syndrome: a single center experience with 20 children.

Roth

TJ,…Department of Urology, Mayo Clinic, Rochester,

Minnesota, USA.

PURPOSE: Recent advances in

neuromodulation have demonstrated promise in treating children with the

dysfunctional elimination syndrome refractory to medical management. Sacral

nerve stimulation with the InterStim implantable device has been used in adults

for management of chronic urinary complaints. However, there are few data

regarding the usefulness of sacral nerve stimulation in children. We report our

experience with sacral nerve stimulation for severe dysfunctional elimination

syndrome. MATERIALS AND METHODS: A total of

20 patients 8 to 17 years old with the dysfunctional elimination syndrome

refractory to maximum medical treatment underwent sacral nerve stimulation at

our institution. Patients were followed prospectively for a median of 27 months

after the procedure. RESULTS: Urinary incontinence, urgency and frequency,

nocturnal enuresis and constipation were improved or resolved in 88% (14 of

16), 69% (9 of 13), 89% (8 of 9), 69% (11 of 16) and 71% (12 of 17) of the

patients, respectively. Urinary retention requiring intermittent

catheterization persisted in 75% of the patients (3 of 4) despite sacral nerve

stimulation. Complications requiring operative treatment occurred in 20% of the

patients (4 of 20). Following marked symptomatic improvement 2 devices were

explanted at 20 and 19 months following placement, and both patients have

remained symptom-free. CONCLUSIONS: Sacral nerve stimulation is effective in

the majority of our patients, and should be considered in children with severe

dysfunctional elimination syndrome refractory to maximum medical treatment.

J

Urol. 2006 Nov;176(5):2227-31.

Preliminary results of sacral neuromodulation

in 23 children.

Humphreys

MR, …Department of Urology, Mayo Clinic, Rochester,

MN, USA.

PURPOSE: Sacral nerve stimulation with InterStim is approved in the United

States for use in adults. Limited data on

the effectiveness of sacral nerve stimulation in children are available. We

report our experience with patients who underwent InterStim placement for the

treatment of severe dysfunctional elimination syndrome, which is defined as a

constellation of functional urinary and gastrointestinal symptoms in patients

without anatomical anomalies or obvious neurological disease, in whom intensive

medical and behavioral therapies have failed to improve symptoms. MATERIALS AND

METHODS: A total of 23 patients 6 to 15 years old with presenting symptoms of

dysfunctional voiding, enuresis, incontinence, urinary tract infections,

bladder pain, urinary retention, urgency, frequency, constipation and/or fecal

soiling were followed for a mean of 13.3 months after InterStim placement.

RESULTS: Of the 19 patients with urinary incontinence 3 (16%) had complete

resolution, 13 (68%) had improvement, 2 (11%) were unchanged and 1 (5%) was

worse (sign test, p = 0.002). Among the 16 patients with nocturnal enuresis 2

(13%) had resolution, 9 (56%) improved, 4 (25%) were unchanged and 1 (6%) was

worse (sign test, p = 0.0063). Of the 15 patients with urinary retention

requiring intervention 9 (60%) had improvement and 1 had worsening symptoms

(sign test, p = 0.022), while 2 of 6 patients (33%) on intermittent catheterization

were able to stop. One patient had development of new incontinence and

enuresis. Bladder pain, urgency, frequency and constipation improved in 67% (8

of 12), 75% (12 of 16), 73% (11 of 15) and 80% (12 of 15) of the patients,

respectively. Medications required postoperatively decreased by an average of 3

per patient (p < 0.001). The overall patient satisfaction rate was 64%,

while that of the caregiver was 67%. Two leads were explanted from the 23

patients. Complications encountered included 1 seroma, 1 episode of skin

sensitivity, 2 device failures and 1 lead revision. CONCLUSIONS: Sacral nerve

stimulation in children is an option for carefully selected patients who have

failed other therapies. Our results show that sacral nerve stimulation was effective

in the majority of patients with the dysfunctional elimination syndrome.

However, longer followup is needed.

Publication Types:Clinical TrialPMID:

17070300