Sacral Nerve Stimulation for Pediatric Lower Urinary Tract Dysfunction: Development of a Standardized Pathway with Objective Urodynamic Outcomes

Schober, Megan S.; Sulkowski, Jason P.; Lu, Peter L.; Minneci, Peter C.; Deans, Katherine J.; Teich, Steven; Alpert, Seth A.

doi:10.1016/j.juro.2015.06.090

Cited by 23 publications

(6 citation statements)

References 17 publications

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“…In 2015, Schober et al concluded significant improvement in voiding dysfunction scores and in urodynamic parameters in a group of 23 children with OAB. 75 Sacral neuromodulation might be a possibility for judiciously selected children with unmanageable OAB.…”

Section: Neuromodulationmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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Overactive bladder (OAB) is a highly prevalent disorder in the pediatric population. This condition is especially troublesome for pediatric patients and their families when associated with incontinence, since it negatively affects self-esteem and impairs children's development. From the patient's perspective, urgency and urge incontinence can have a significant impact, negatively affecting their quality of life. For a therapy to have true benefit, changes must not only be statistically significant, but must also be perceived as meaningful by the patient. A stepwise approach is favoured to treat this pathology, starting with behavioural therapy, followed by medical management, and eventually more invasive procedures.Antimuscarinic agents are the mainstay of medical treatment for OAB. Oxybutynin is the most commonly used antimuscarinic in the pediatric population. However, some patients have a suboptimal response to antimuscarinics and many experience bothersome side effects, which have been documented with all antimuscarinics to a significantly higher degree than placebo. Although there have been reports about the use of tolterodine, fesoterodine, trospium, propiverine, and solifenacin in children, to date, only oxybutynin has been officially approved for pediatric use by medical authorities in North America. This review will address alternative treatment options for pediatric patients presenting with OAB, from conservative measures to more invasive therapies.

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Section: Neuromodulationmentioning

confidence: 99%

Overactive bladder in children

Ramsay¹,

Bolduc²

2017

CUAJ

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“…Information about improvement in urinary symptoms could not be assessed since this was not consistently reported for our ACE patients in the medical record. Although SNS is considered effective in treating urinary symptoms, 16,27 it would be interesting to compare results between SNS and ACE in children with FC. Moreover, the use of Malone as an antegrade option for FC at our institution became more widely available during the time span of this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Vriesman

Wang

Park

et al. 2020

Neurogastroenterology Motil

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Background To compare antegrade continence enema (ACE) treatment and sacral nerve stimulation (SNS) in children with intractable functional constipation (FC) and fecal incontinence (FI). Methods We performed a retrospective review of children 6‐18 years old with FC and FI treated with either ACE or SNS at our institution. We recorded symptoms at baseline, 6 months, 12 months, 24 months, and their most recent visit after starting treatment. We compared improvement in FI, bowel movement (BM) frequency, abdominal pain, laxative use, and complications. Patients were contacted to evaluate perceived benefit using the Glasgow Children's Benefit Inventory. Key Results We included 23 patients treated with ACE (52% female, median age 10 years) and 19 patients treated with SNS (74% female, median age 10 years). Improvement in FI was greater with SNS than ACE at 12 months (92.9% vs 57.1%, P = .03) and 24 months (100% vs 57.1%, P = .02). Improvement in BM frequency was greater with ACE, and children were more likely to discontinue laxatives at all follow‐up time points (all P < .05). Improvement in abdominal pain was greater with ACE at the most recent visit (P < .05). Rate of complications requiring surgery was similar between groups (26.3% vs 21.7%). Benefit was reported in 83.3% and 100% of ACE and SNS groups, respectively (NS). Conclusions and Inferences Although both ACE and SNS can lead to durable improvement in children with FC and FI, SNS appears more effective for FI and ACE more effective in improving BM frequency and abdominal pain and in discontinuation of laxatives.

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“…One wonders, if this effect is sustained, perhaps future, adult LUTS with initial treatment in childhood could be altered or eliminated. Explant surveys for those explanted for cure and complication.^Raw scores in the cure cohort were 5,8,9,15,16. * Based upon cut-off score of 11 suggested by Afsar et al [12].…”

Section: Discussionmentioning

confidence: 99%

Pediatric sacral nerve stimulator explanation due to complications or cure: a survival analysis

Rensing

Szymański

Dunn

et al. 2019

Journal of Pediatric Urology

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Sacral Nerve Stimulation for Pediatric Lower Urinary Tract Dysfunction: Development of a Standardized Pathway with Objective Urodynamic Outcomes

Abstract: 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.

Cited by 23 publications

References 17 publications

Overactive bladder in children

Overactive bladder in children

Comparison of antegrade continence enema treatment and sacral nerve stimulation for children with severe functional constipation and fecal incontinence

Pediatric sacral nerve stimulator explanation due to complications or cure: a survival analysis

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