PURPOSE: 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. MATERIALS AND 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.
PURPOSE: 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. MATERIALS AND 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.
Authors: Jose Carlos Truzzi; Cristiano Mendes Gomes; Carlos A Bezerra; Ivan Mauricio Plata; Jose Campos; Gustavo Luis Garrido; Fernando G Almeida; Marcio Augusto Averbeck; Alexandre Fornari; Anibal Salazar; Arturo Dell'Oro; Caio Cintra; Carlos Alberto Ricetto Sacomani; Juan Pablo Tapia; Eduardo Brambila; Emilio Miguel Longo; Flavio Trigo Rocha; Francisco Coutinho; Gabriel Favre; Jose Antonio Garcia; Juan Castano; Miguel Reyes; Rodrigo Eugenio Leyton; Ruiter Silva Ferreira; Sergio Duran; Vanda Lopez; Ricardo Reges Journal: Int Braz J Urol Date: 2016 Mar-Apr Impact factor: 1.541
Authors: Aart A van der Wilt; Bart P W van Wunnik; Rosel Sturkenboom; Ingrid J Han-Geurts; Jarno Melenhorst; Marc A Benninga; Cor G M I Baeten; Stephanie O Breukink Journal: Int J Colorectal Dis Date: 2016-06-13 Impact factor: 2.571