Sacral Neuromodulation (SNM) has emerged as a venerable treatment modality for voiding dysfunction (VD) and non-obstructive urinary retention (NOUR) in the adult population. However, it is imperative to recognize that these urological conditions also manifest with notable frequency in adolescents, leading to considerable detriment to their quality of life. These disorders predispose to recurrent urinary tract infections and elevate the risks of vesicoureteral reflux and renal compromise. The current therapeutic landscape predominantly encompasses clean intermittent catheterization or the employment of indwelling catheters; nonetheless, these approaches may not be universally effective or acceptable. The present study endeavors to conduct a retrospective analysis of the functional and clinical outcomes associated with SNM in pediatric patients diagnosed with VD and NOUR.

In this retrospective evaluation, we reviewed clinical data from patients who underwent SNM between 2018 and 2023 for the treatment of VD or NOUR, ensuring that all subjects had a minimum follow-up duration of one year. Informed consent was duly obtained from all participants prior to the commencement of the treatment. The implantation procedures incorporated the Medtronic Interstim II devices, utilizing a two-stage technique in which a quadripolar electrode was strategically positioned at the S3 sacral nerve root under fluoroscopic guidance. The study rigorously assessed a multitude of outcomes, encompassing clinical and urodynamic changes, patient-reported perceptions, as well as complications and circumstances necessitating device explantation.

A total of 21 patients were included in the analysis, 11 females (52.3%) and 10 males (47.7%). The mean age at the time of implantation was 13.76 years, with an age range spanning from 7 to 17 years. Urodynamic evaluations revealed that 66.6% of patients (14 individuals) exhibited notable improvements in uroflowmetry, particularly concerning alterations in post-void residual (PVR) volumes. Conversely, 23.8% (5 patients) demonstrated no significant improvement, while 9.5% (2 patients) experienced an increase in PVR. An impressive 95.2% of patients (20 individuals) expressed satisfaction regarding their social and self-perceptual well-being. However, one patient (4.7%) necessitated the removal of the sacral neuromodulator just one week post-implantation due to a somatoform disorder. Early postoperative complications were encountered in 9.5% of patients (2 individuals), with issues including surgical site infection and implant extrusion. Additionally, four patients (19%) opted for explantation: one patient (4.7%) faced chronic urinary retention accompanied by stress urinary incontinence, another (4.7%) could not tolerate the pacemaker, a third (4.7%) presented with an areflexic bladder and significantly reduced bladder proprioceptive sensitivity, and the final patient (4.7%) reported a lack of therapeutic benefit from the intervention.

The findings elucidate that a substantial majority of patients (66.6%) experienced marked improvements in uroflowmetry subsequent to implantation, thereby underscoring the intervention's efficacy in ameliorating bladder function. Furthermore, the elevated satisfaction rate (95.2%) attests to the positive ramifications of SNM on the patients' social engagement and self-perception, notwithstanding the occurrence of complications and explantations, which underscore the necessity for judicious patient selection and vigilant postoperative management.

Sacral Neuromodulation represents a promising therapeutic avenue for the management of voiding dysfunction in paediatric patients, particularly those deemed suitable candidates. Future investigations are warranted to further elucidate long-term outcomes and refine the criteria for patient selection in relation to this intervention.