As the indications for sacral neuromodulation grow, so do the patient populations that can benefit from the device. Sacral neuromodulation is approved by the FDA for urinary frequency, urgency, urge incontinence, nonobstructive urinary retention and fecal incontinence in adults. Many studies have shown efficacy for these disorders for adults, but similar data regarding pediatric patients is lacking. Currently the FDA states that the safety and efficacy of sacral neuromodulation in patients under 16 years of age have not been established.
A recent publication, Prospective evaluation of sacral neuromodulation in children: outcomes and urodynamics predictors of success, Mason MD, Stephany DP, Casella D B, Journal of Urology, presents a prospective study of 26 children who underwent stage 1 and 2 sacral neuromodulation. Study participants had bowel bladder dysfunction (BBD): a combination of functional bladder and bowel disturbances including increased or decreased urinary frequency, urgency, bladder underactivity and constipation. Participants were 5-17 years of age and had BBD refractory to conservative measures, physiotherapy and medical management. No participant had an underlying neurologic disorder. Median follow up was 14.8 months. Seven of 30 patients experienced a complication requiring operative intervention, most of which were broken leads in active youngsters. All patients (10 subjects) taking preoperative anticholinergics discontinued them after implantation due to symptom improvement. Mean psychosocial QOL score and the total QOL score improved significantly after implantation. BBD symptoms as evaluated by questionnaire also improved significantly. The urodynamic finding with greatest predictive success for improvement was detrusor overactivity.
For those of us who see children with refractory bowel bladder dysfunction, sacral neuromodulation offers hope for another management option. Despite several limitations including small study cohort and seemingly high lead breakage rate, this study provides much-needed data on the subject. In addition to safety and efficacy data, information regarding patient selection and the management of unwanted post operative events is invaluable.
Article by the Publications and Communications Committee
Mason MD, Stephany DP, Casella D B, Prospective evaluation of sacral neuromodulation in children: outcomes and urodynamics predictors of success, Journal of Urology